MEDICARE: DR. RICHARD A 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
1	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	25708	TN
2	208000000X	Pediatrics Physician	25708	TN

General Provider Information

NPI Number	:	1336149558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD A NELSON MD

Provider Business Mailing Address
First Line	:	2595 CENTRAL AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-5905
Country	:	US
Telephone Number	:	901-260-8500
Fax Number	:	901-260-8598

Provider Business Practice Location Address
First Line	:	969 FRAYSER BLVD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38127-5977
Country	:	US
Telephone Number	:	901-701-2540
Fax Number	:	901-260-8449

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	03/21/2017

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