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General NPI Number Information
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NPI Number | 1487735098
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Entity Type | Organization
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Legal Business Name | ROY G. NELSON MD PC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 90 HEALTH PARK DR SUITE 200
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City | LOUISVILLE
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State | CO
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Zip | 80027-9757
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Country | US
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Telephone | 303-673-9001
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Fax |
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Provider Business Mailing Address
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Address Line | 90 HEALTH PARK DR SUITE 200
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City | LOUISVILLE
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State | CO
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Zip | 80027-9757
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Country | US
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Telephone | 303-673-9001
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ROY GUNNAR NELSON
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Credential | M. D.
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Telephone | 303-673-9001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 23781
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License Number State | CO
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