Healthcare Provider Details

I. General information

NPI: 1093789703
Provider Name (Legal Business Name): DAVID W NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 12/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135-116TH AVENUE NE SUITE 605
BELLEVUE WA
98004
US

IV. Provider business mailing address

PO BOX 3947 MS 315010
SEATTLE WA
98124-3947
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-8161
  • Fax: 425-454-6304
Mailing address:
  • Phone: 425-467-3655
  • Fax: 480-782-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number33733
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number33733
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD60244683
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: