MEDICARE: LEONARD D NELSON JR. 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
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	38816	NC
2	207X00000X	Orthopaedic Surgery Physician	38816	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1326041104	OTHER	NC	NPI

General Provider Information

NPI Number	:	1326041104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD D NELSON JR. MD

Provider Business Mailing Address
First Line	:	3001 EDWARDS MILL RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-5243
Country	:	US
Telephone Number	:	919-781-5600
Fax Number	:	919-863-6856

Provider Business Practice Location Address
First Line	:	3001 EDWARDS MILL RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-5243
Country	:	US
Telephone Number	:	919-781-5600
Fax Number	:	919-863-6856

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/23/2017

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