Provider Demographics
NPI:1497787741
Name:NELSON, STEPHEN LEWIS JR (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEWIS
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1415 TULANE AVE
Mailing Address - Street 2:ROOM 6809
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2600
Mailing Address - Country:US
Mailing Address - Phone:504-988-6751
Mailing Address - Fax:504-988-2568
Practice Address - Street 1:4720 S I-1-10 SERVICE RD SUITE 401
Practice Address - Street 2:
Practice Address - City:METARIE
Practice Address - State:LA
Practice Address - Zip Code:70001
Practice Address - Country:US
Practice Address - Phone:504-988-9235
Practice Address - Fax:504-988-7654
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD71165208000000X
LA2016972084N0402X
MS199212084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1021075Medicaid
CA00A845150Medicaid
LA4K815DB49Medicare PIN
CAI09116Medicare UPIN