Provider Demographics
NPI:1093379315
Name:AUSTIN T. NELSON, MD, P.C.
Entity Type:Organization
Organization Name:AUSTIN T. NELSON, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-667-8073
Mailing Address - Street 1:19653 S MITKOF LOOP
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8692
Mailing Address - Country:US
Mailing Address - Phone:210-667-8073
Mailing Address - Fax:907-569-1433
Practice Address - Street 1:3851 PIPER ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4684
Practice Address - Country:US
Practice Address - Phone:907-569-1333
Practice Address - Fax:907-569-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty