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NPI Code Detail

MEDICARE: MR. JOHN ANDREW NELSON P.A.-C

MEDICARE: MR. JOHN ANDREW NELSON P.A.-C
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
1363A00000XPhysician Assistant6722AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1IL0105OTHERJOHN DEERE HEALTH PLANS
205732036OTHERILBLUE SHIELD GROUP NUMBERT
3068816OTHERHEALTH ALLIANCE PROVIDER
4085000447003OTHEROSF HEALTH PLANS
5661684OTHERHEALTHLINK
637945OTHERTIRCARE

General Provider Information

NPI Number : 1992799662
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN ANDREW NELSON P.A.-C
Provider Business Mailing Address
First Line : 18444 N 25TH AVE STE 310
Second Line :
City : PHOENIX
State : AZ
Zip : 85023-1266
Country : US
Telephone Number : 866-974-2673
Fax Number : 866-939-2673
Provider Business Practice Location Address
First Line : 1500 S DOBSON RD STE 202
Second Line :
City : MESA
State : AZ
Zip : 85202-4724
Country : US
Telephone Number : 866-974-2673
Fax Number : 866-974-2673
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2005
Last Update Date : 09/26/2022

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