Healthcare Provider Details

I. General information

NPI: 1578522892
Provider Name (Legal Business Name): SCOTT NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 CONEJO DR
SANTA FE NM
87505
US

IV. Provider business mailing address

PO BOX 6081
SANTA FE NM
87502-6081
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-8584
  • Fax:
Mailing address:
  • Phone: 505-424-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number76240
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: