MEDICARE: ROY G. NELSON MD PC

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	2080A0000X	Pediatric Adolescent Medicine Physician	23781	CO

Other Identifiers

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

General Provider Information

NPI Number	:	1487735098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROY G. NELSON MD PC

Provider Business Mailing Address
First Line	:	90 HEALTH PARK DR
Second Line	:	SUITE 200
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-9757
Country	:	US
Telephone Number	:	303-673-9001
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 HEALTH PARK DR
Second Line	:	SUITE 200
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-9757
Country	:	US
Telephone Number	:	303-673-9001
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ROY GUNNAR NELSON
Credential	:	M. D.
Telephone Number	:	303-673-9001

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	06/23/2008

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