MEDICARE: DR. NELSON CHARLIE 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	207N00000X	Dermatology Physician	ME85619	FL
2	207NS0135X	Procedural Dermatology Physician	ME85619	FL

General Provider Information

NPI Number	:	1811998982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NELSON CHARLIE M.D.

Provider Business Mailing Address
First Line	:	1800 SE 10TH AVE
Second Line	:	SUITE 305
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2901
Country	:	US
Telephone Number	:	954-467-4100
Fax Number	:	954-467-4080

Provider Business Practice Location Address
First Line	:	1800 SE 10TH AVE
Second Line	:	SUITE 305
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2901
Country	:	US
Telephone Number	:	954-467-4100
Fax Number	:	954-467-4080

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/03/2013

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Directions to “ DR. NELSON CHARLIE M.D.” Practice Location

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