Provider Demographics
NPI:1447589478
Name:NELSON, ROBERT GEOFFREY (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GEOFFREY
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 E INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4972
Mailing Address - Country:US
Mailing Address - Phone:602-200-5205
Mailing Address - Fax:602-200-5225
Practice Address - Street 1:1550 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4972
Practice Address - Country:US
Practice Address - Phone:602-200-5205
Practice Address - Fax:602-200-5225
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15217207R00000X
CAG43266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine