Healthcare Provider Details

I. General information

NPI: 1942251202
Provider Name (Legal Business Name): THOMAS MARK NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 1ST ST SUITE P302
DULUTH MN
55805-2201
US

IV. Provider business mailing address

301 HIGHWAY 65 S
MORA MN
55051-1899
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-6050
  • Fax:
Mailing address:
  • Phone: 320-225-3317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34418
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: