Provider Demographics
NPI:1457310229
Name:NEILSON, DOUGLAS D (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:D
Last Name:NEILSON
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 1:2007 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-2030
Mailing Address - Country:US
Mailing Address - Phone:605-689-6890
Mailing Address - Fax:605-689-6896
Practice Address - Street 1:2007 LOCUST ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-2030
Practice Address - Country:US
Practice Address - Phone:605-689-6890
Practice Address - Fax:605-689-6896
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4099207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4099OtherSTATE LICENSE
SD4099OtherSTATE LICENSE