MEDICARE: DR. RYAN LEE NELSON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	4672	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	.	OTHER		NA

General Provider Information

NPI Number	:	1225292444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN LEE NELSON DO

Provider Business Mailing Address
First Line	:	14024 QUAIL POINTE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1006
Country	:	US
Telephone Number	:	405-419-8447
Fax Number	:	405-419-7745

Provider Business Practice Location Address
First Line	:	9800 BROADWAY EXT STE 203
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-6304
Country	:	US
Telephone Number	:	405-330-8847
Fax Number	:	405-330-8849

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	04/21/2020

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