Provider Demographics
NPI:1558360396
Name:NELSON, JAMES H III (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:NELSON
Suffix:III
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 1:370 RETREAT LN W
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9769
Mailing Address - Country:US
Mailing Address - Phone:614-929-4085
Mailing Address - Fax:
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 1602
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-522-5055
Practice Address - Fax:808-522-5333
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-037157208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0339413Medicaid
OH000000341516OtherANTHEM
OH1901153OtherUHC
OH1901153OtherUHC
OHA75337Medicare UPIN