Provider Demographics
NPI:1083632061
Name:NELSON, JOHN E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:530 W OJAI AVE
Mailing Address - Street 2:206
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2462
Mailing Address - Country:US
Mailing Address - Phone:805-640-8549
Mailing Address - Fax:805-640-8624
Practice Address - Street 1:530 W OJAI AVE
Practice Address - Street 2:206
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2462
Practice Address - Country:US
Practice Address - Phone:805-640-8549
Practice Address - Fax:805-640-8624
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG191712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G19710Medicare ID - Type Unspecified
CAA90584Medicare UPIN