Provider Demographics
NPI:1164499349
Name:NELSON, WILLIAM GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GEORGE
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2960 WINNETKA AVE N
Mailing Address - Street 2:STE 208
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55427
Mailing Address - Country:US
Mailing Address - Phone:763-512-1090
Mailing Address - Fax:763-512-1081
Practice Address - Street 1:2960 WINNETKA AVE N
Practice Address - Street 2:STE 208
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55427
Practice Address - Country:US
Practice Address - Phone:763-512-1090
Practice Address - Fax:763-512-1081
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN324162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
108933OtherUCARE
98032NEOtherCCS
HP14045OtherHP
98032NEOtherBCBS
1520187OtherMEDCA
31674500OtherWMA
98032NEOtherBCSL
0820004OtherPRE 1
1520187OtherUHC
4118057502OtherHNHP
98032NEOtherBLUE
98032NEOtherBCBSM
1520187OtherUHIC
98032NEOtherEPNI
98032NEOtherBCBS