Provider Demographics
NPI:1588620694
Name:NELSON, ROBERT B (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1497 W ELK AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643
Mailing Address - Country:US
Mailing Address - Phone:423-542-7480
Mailing Address - Fax:423-542-7485
Practice Address - Street 1:1497 W ELK AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643
Practice Address - Country:US
Practice Address - Phone:423-542-7480
Practice Address - Fax:423-542-7485
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNTN29315207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN01U3OtherJOHN DEERE
TN4095398OtherBCBS
TN3811044Medicaid
TN3811044Medicare ID - Type Unspecified
C85727Medicare UPIN