Provider Demographics
NPI:1053313783
Name:NELSON, ROBERT SAMUEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SAMUEL
Last Name:NELSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8546 NW 18TH PL
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6149
Mailing Address - Country:US
Mailing Address - Phone:954-575-9456
Mailing Address - Fax:954-575-9456
Practice Address - Street 1:8546 NW 18TH PL
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6149
Practice Address - Country:US
Practice Address - Phone:954-575-9456
Practice Address - Fax:954-575-9456
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002554213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65449OtherMEDICARE ID
FL390294301Medicaid
FL390294301Medicaid
FL5147690001Medicare NSC