Provider Demographics
NPI:1386639474
Name:NELSON, CHRISTOPHER LEE (MD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LEE
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 1:10301 CHAMPION FARMS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6129
Mailing Address - Country:US
Mailing Address - Phone:502-423-1021
Mailing Address - Fax:502-423-1416
Practice Address - Street 1:42 BUSINESS CENTRE DR
Practice Address - Street 2:SUITE 308
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-6920
Practice Address - Country:US
Practice Address - Phone:850-460-8778
Practice Address - Fax:850-460-8779
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37667208VP0014X
NC200201130207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64065196Medicaid
NC1329FOtherBLUE CROSS BLUE SHIELD NORTH CAROLINA
KY37667OtherMEDICAL LICENSE
FLME 123663OtherFL LICENSE
FLME 123663OtherFL LICENSE
KY64065196Medicaid
KY00635001Medicare PIN