Provider Demographics
NPI:1104018415
Name:NANSON, JOHN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:NANSON
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 1:1190 S SUNDOWN RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-5105
Mailing Address - Country:US
Mailing Address - Phone:928-777-9155
Mailing Address - Fax:928-778-7618
Practice Address - Street 1:1607 E 33RD ST
Practice Address - Street 2:ELLEFSON FREE CLINIC
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-2705
Practice Address - Country:US
Practice Address - Phone:515-266-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20112208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice