Provider Demographics
NPI:1376595074
Name:NELSON, JOSIAH D (MD)
Entity Type:Individual
Prefix:
First Name:JOSIAH
Middle Name:D
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 1:3217 STEIN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6995
Mailing Address - Country:US
Mailing Address - Phone:715-835-6548
Mailing Address - Fax:715-835-7708
Practice Address - Street 1:3217 STEIN BOULEVARD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6995
Practice Address - Country:US
Practice Address - Phone:715-835-6548
Practice Address - Fax:715-835-7708
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48491208800000X
WI48491-020208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI48491-020OtherLICENSE
WI100002959Medicaid
WI48491-020OtherLICENSE