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NPI Code Detail

MEDICARE: EUSTUS S NELSON MD PA

MEDICARE: EUSTUS S NELSON MD PA
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
1208800000XUrology PhysicianME45558FL

General Provider Information

NPI Number : 1306030549
Entity Type Code : Organization
Provider Name (Legal Business Name) : EUSTUS S NELSON MD PA
Provider Business Mailing Address
First Line : 4215 SUN N LAKE BLVD
Second Line :
City : SEBRING
State : FL
Zip : 33872-2158
Country : US
Telephone Number : 863-382-2248
Fax Number : 863-382-1242
Provider Business Practice Location Address
First Line : 4215 SUN N LAKE BLVD
Second Line :
City : SEBRING
State : FL
Zip : 33872-2158
Country : US
Telephone Number : 863-382-2248
Fax Number : 863-382-1242
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. NOREEN M NELSON
Credential : RN
Telephone Number : 863-382-2248
Provider Enumeration Date : 08/30/2007
Last Update Date : 08/30/2007

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Directions to “EUSTUS S NELSON MD PA ” Practice Location

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