Healthcare Provider Details

I. General information

NPI: 1720056765
Provider Name (Legal Business Name): DAVID MATTHEW NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 FRANCE AVE S STE 4100
EDINA MN
55435-5924
US

IV. Provider business mailing address

7600 FRANCE AVE S STE 4100
EDINA MN
55435-5924
US

V. Phone/Fax

Practice location:
  • Phone: 952-831-1551
  • Fax: 952-931-0725
Mailing address:
  • Phone: 952-831-1551
  • Fax: 952-831-0725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40769
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: