Healthcare Provider Details

I. General information

NPI: 1841230927
Provider Name (Legal Business Name): MILES J NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 GOLF COURSE RD NW
ALBUQUERQUE NM
87114-5019
US

IV. Provider business mailing address

PO BOX 2505
SALEM OR
97308-2505
US

V. Phone/Fax

Practice location:
  • Phone: 615-928-6268
  • Fax:
Mailing address:
  • Phone: 888-828-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number93-346
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: