Provider Demographics
NPI:1063443281
Name:NELSON, SAMUEL ARNOLD (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ARNOLD
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ARNOLD
Other - Middle Name:SAMUEL
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:518 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-7818
Mailing Address - Country:US
Mailing Address - Phone:520-623-8556
Mailing Address - Fax:520-896-2277
Practice Address - Street 1:518 E 1ST ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7818
Practice Address - Country:US
Practice Address - Phone:520-623-8556
Practice Address - Fax:520-896-2277
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ75902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ243460Medicaid