Provider Demographics
NPI:1033220850
Name:NELSON, DAVID LINCOLN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LINCOLN
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 S ELISEO DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2012
Mailing Address - Country:US
Mailing Address - Phone:415-925-0501
Mailing Address - Fax:415-461-4274
Practice Address - Street 1:1363 S ELISEO DR
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2012
Practice Address - Country:US
Practice Address - Phone:415-925-0501
Practice Address - Fax:415-461-4274
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50450207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE13848Medicare UPIN
CA00G504500Medicare ID - Type Unspecified