Provider Demographics
NPI:1558983502
Name:NEILSON, JON HYRUM II (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:HYRUM
Last Name:NEILSON
Suffix:II
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 1:6060 N FOUNTAIN PLAZA DR STE 250
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7873
Mailing Address - Country:US
Mailing Address - Phone:520-258-0582
Mailing Address - Fax:
Practice Address - Street 1:6060 N FOUNTAIN PLAZA DR STE 250
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7873
Practice Address - Country:US
Practice Address - Phone:520-258-0582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR78250208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics