MEDICARE: DR. PAUL J 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
1	174400000X	Specialist	12057	NE

General Provider Information

NPI Number	:	1841239019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL J NELSON MD

Provider Business Mailing Address
First Line	:	10105 MAPLE ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-5554
Country	:	US
Telephone Number	:	402-572-3140
Fax Number	:

Provider Business Practice Location Address
First Line	:	10105 MAPLE ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-5554
Country	:	US
Telephone Number	:	402-572-3140
Fax Number	:

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	06/29/2010

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