Healthcare Provider Details

I. General information

NPI: 1376768739
Provider Name (Legal Business Name): JAMES DALLAS NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UPPERHAVENSITE BLD3 305
ST THOMAS VI
00802
US

IV. Provider business mailing address

UPPERHAVENSITE BLD3 305
ST THOMAS VI
00802
US

V. Phone/Fax

Practice location:
  • Phone: 340-774-3633
  • Fax: 340-776-2552
Mailing address:
  • Phone: 340-774-3633
  • Fax: 340-776-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number897
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: