Provider Demographics
NPI:1306864301
Name:NELSON, LARRY F (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:F
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:PO BOX 10203
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-0203
Mailing Address - Country:US
Mailing Address - Phone:337-367-2812
Mailing Address - Fax:337-369-3536
Practice Address - Street 1:2315 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4031
Practice Address - Country:US
Practice Address - Phone:337-367-2812
Practice Address - Fax:337-369-3536
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015421207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1346691Medicaid
D08952Medicare UPIN
LA1346691Medicaid