MEDICARE: DR. GARTH CHAD NELSON M.D.

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	38826	CO

General Provider Information

NPI Number	:	1356394746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARTH CHAD NELSON M.D.

Provider Business Mailing Address
First Line	:	1020 LUKE ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4016
Country	:	US
Telephone Number	:	970-493-2102
Fax Number	:	970-493-9035

Provider Business Practice Location Address
First Line	:	1020 LUKE ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4016
Country	:	US
Telephone Number	:	970-493-2102
Fax Number	:	970-493-9035

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/31/2008

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