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NPI Code Detail

MEDICARE: DR. JERRY ALAN NELSON MD

MEDICARE: DR. JERRY ALAN 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
1207Q00000XFamily Medicine Physician36749IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
221827OTHERIAWELLMARK
321828OTHERIAWELLMARK
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831197607
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JERRY ALAN NELSON MD
Provider Business Mailing Address
First Line : 905 FRANKLIN ST
Second Line :
City : WATERLOO
State : IA
Zip : 50703-4407
Country : US
Telephone Number : 319-272-4300
Fax Number : 319-272-4411
Provider Business Practice Location Address
First Line : 905 FRANKLIN ST
Second Line :
City : WATERLOO
State : IA
Zip : 50703-4407
Country : US
Telephone Number : 319-272-4300
Fax Number : 319-272-4411
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 07/22/2013

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