Provider Demographics
NPI:1487673299
Name:NELSON, BYRON L (MD)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:L
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 1:833 CEDAR BLUFF RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-1005
Mailing Address - Country:US
Mailing Address - Phone:256-266-1441
Mailing Address - Fax:256-266-1024
Practice Address - Street 1:833 CEDAR BLUFF RD STE 100
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-1005
Practice Address - Country:US
Practice Address - Phone:256-266-1441
Practice Address - Fax:256-266-1024
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533763OtherBCBS
AL51533763OtherBCBS
ALC73804Medicare UPIN