Provider Demographics
NPI:1164498820
Name:NELSON, BRYAN A (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:A
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:763-587-9130
Practice Address - Street 1:11475 ROBINSON DRIVE NW-MAILSTOP 32600A
Practice Address - Street 2:HEALTHPARTNERS COON RAPIDS CLINIC
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3746
Practice Address - Country:US
Practice Address - Phone:763-587-9000
Practice Address - Fax:763-587-9130
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-12-14
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Provider Licenses
StateLicense IDTaxonomies
MN43744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH57251Medicare UPIN