Provider Demographics
NPI:1447209721
Name:NELSON, STEPHEN GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GEORGE
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 1:5601 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-1205
Mailing Address - Country:US
Mailing Address - Phone:727-525-2161
Mailing Address - Fax:
Practice Address - Street 1:5601 9TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-1205
Practice Address - Country:US
Practice Address - Phone:727-525-2161
Practice Address - Fax:727-527-1968
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32477208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics