Provider Demographics
NPI:1467530576
Name:NELSON, ANTHONY A (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:A
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:P.O. BOX 3023
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1092
Mailing Address - Country:US
Mailing Address - Phone:760-202-1919
Mailing Address - Fax:760-202-1982
Practice Address - Street 1:71780 SAN JACINTO DRIVE
Practice Address - Street 2:SUITE B3
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1092
Practice Address - Country:US
Practice Address - Phone:760-202-1919
Practice Address - Fax:760-202-1982
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61216207L00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G612160Medicare ID - Type UnspecifiedMEDICARE NUMBER INDIV.
CAZZZ05102ZMedicare PIN
CA00G612162Medicare PIN