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General NPI Number Information
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NPI Number | 1942251202
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Entity Type | Individual
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Provider Name | THOMAS MARK NELSON MD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 920 E 1ST ST SUITE P302
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City | DULUTH
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State | MN
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Zip | 55805-2201
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Country | US
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Telephone | 218-249-6050
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Fax |
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Provider Business Mailing Address
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Address Line | 301 HIGHWAY 65 S
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City | MORA
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State | MN
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Zip | 55051-1899
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Country | US
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Telephone | 320-225-3317
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 34418
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License Number State | MN
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