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General NPI Number Information
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NPI Number | 1124029319
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Entity Type | Individual
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Provider Name | JOHN CHRISTOPHER NELSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 12/08/2015
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Provider Practice Location Address
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Address Line | 3327 TIMBER FALL CT
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City | EUREKA
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State | CA
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Zip | 95503-4894
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Country | US
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Telephone | 707-445-8443
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Fax | 707-445-2209
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Provider Business Mailing Address
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Address Line | 3327 TIMBER FALL CT
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City | EUREKA
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State | CA
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Zip | 95503-4894
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Country | US
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Telephone | 707-445-8443
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Fax | 707-445-2209
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G74722
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License Number State | CA
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