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NPI Code Detail

MEDICARE: TODD ROBERT NELSON MD

MEDICARE: TODD ROBERT 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
1207R00000XInternal Medicine Physician365595-1205UT
2207Q00000XFamily Medicine Physician365595-1205UT

General Provider Information

NPI Number : 1902917495
Entity Type Code : Individual
Provider Name (Legal Business Name) : TODD ROBERT NELSON MD
Provider Business Mailing Address
First Line : 2965 W 3500 S
Second Line :
City : WEST VALLEY CITY
State : UT
Zip : 84119-3602
Country : US
Telephone Number : 801-965-3600
Fax Number :
Provider Business Practice Location Address
First Line : 999 E MURRAY HOLLADAY RD
Second Line :
City : MILLCREEK
State : UT
Zip : 84117-4901
Country : US
Telephone Number : 801-965-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 04/18/2024

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Directions to “ TODD ROBERT NELSON MD” Practice Location

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