Provider Demographics
NPI:1184631053
Name:NELSON, PERCY LEE (DPM)
Entity Type:Individual
Prefix:
First Name:PERCY
Middle Name:LEE
Last Name:NELSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 NE 203RD ST
Mailing Address - Street 2:STE 100A
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1945
Mailing Address - Country:US
Mailing Address - Phone:305-466-9498
Mailing Address - Fax:305-466-9698
Practice Address - Street 1:21110 BISCAYNE BLVD
Practice Address - Street 2:201
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1227
Practice Address - Country:US
Practice Address - Phone:305-466-9498
Practice Address - Fax:305-466-9698
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-2542213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1093072589OtherNPI
FL3902935-00Medicaid
FL65423Medicare UPIN