MEDICARE: DOUGLAS ALAN 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	207RH0000X	Hematology (Internal Medicine) Physician	56196	KY
2	207RX0202X	Medical Oncology Physician	56196	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56196	OTHER	KY	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8V4667	OTHER	TX	BCBS (MDACC)

General Provider Information

NPI Number	:	1497720049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS ALAN NELSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 776347
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6347
Country	:	US
Telephone Number	:	502-272-5052
Fax Number	:	502-629-6217

Provider Business Practice Location Address
First Line	:	676 S FLOYD ST STE 200
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1840
Country	:	US
Telephone Number	:	502-629-4440
Fax Number	:	502-629-4445

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	01/10/2025

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Directions to “ DOUGLAS ALAN NELSON M.D.” Practice Location

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