Provider Demographics
NPI:1417957507
Name:NELSON, EUSTUS STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:EUSTUS
Middle Name:STEPHEN
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 1:4215 SUN N LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2158
Mailing Address - Country:US
Mailing Address - Phone:863-382-2248
Mailing Address - Fax:863-382-1242
Practice Address - Street 1:4215 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2158
Practice Address - Country:US
Practice Address - Phone:863-382-2248
Practice Address - Fax:863-382-1242
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45558208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008356800Medicaid
FL28130WMedicare UPIN
D53494Medicare UPIN