Provider Demographics
NPI:1528181955
Name:NIELSEN, JAMES BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BARRY
Last Name:NIELSEN
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 1:128 S 1000 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1403
Mailing Address - Country:US
Mailing Address - Phone:801-355-5549
Mailing Address - Fax:
Practice Address - Street 1:128 S 1000 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1403
Practice Address - Country:US
Practice Address - Phone:801-355-5549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT158321-1205207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD99482Medicare UPIN
UT000005175Medicare ID - Type Unspecified