Provider Demographics
NPI:1164539722
Name:NELSON, RAYMOND CURTIS (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:CURTIS
Last Name:NELSON
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 1:10 KRUGER RD
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859-9506
Mailing Address - Country:US
Mailing Address - Phone:406-826-4816
Mailing Address - Fax:406-826-4898
Practice Address - Street 1:120 POND RD
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873
Practice Address - Country:US
Practice Address - Phone:406-826-4816
Practice Address - Fax:406-826-4898
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTPENDINGMedicaid
MTPENDINGMedicaid
MTC51019Medicare UPIN