MEDICARE: ERIC W NELSON D.P.M.

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	213E00000X	Podiatrist	E2453	CA

General Provider Information

NPI Number	:	1902899263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC W NELSON D.P.M.

Provider Business Mailing Address
First Line	:	13847 E 14TH ST
Second Line	:	STE 210
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2632
Country	:	US
Telephone Number	:	510-351-7552
Fax Number	:	510-351-6009

Provider Business Practice Location Address
First Line	:	13847 E 14TH ST
Second Line	:	STE 210
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2632
Country	:	US
Telephone Number	:	510-351-7552
Fax Number	:	510-351-6009

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	11/01/2007

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