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NPI Code Detail

MEDICARE: DR. DOUGLAS P NELSON MD

MEDICARE: DR. DOUGLAS P NELSON MD
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
1207R00000XInternal Medicine Physician24103AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265475958
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS P NELSON MD
Provider Business Mailing Address
First Line : 2929 E THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-8034
Country : US
Telephone Number : 602-470-5000
Fax Number :
Provider Business Practice Location Address
First Line : 33 W TAMARISK ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85041-2422
Country : US
Telephone Number : 602-344-6400
Fax Number : 602-344-6401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 09/15/2011

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