Provider Demographics
NPI:1588657449
Name:NELSON, ROBERT SHERWOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SHERWOOD
Last Name:NELSON
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 1:600 6TH STREET S.
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4813
Mailing Address - Country:US
Mailing Address - Phone:727-822-6763
Mailing Address - Fax:727-821-0649
Practice Address - Street 1:600 6TH STREET S.
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4813
Practice Address - Country:US
Practice Address - Phone:727-822-6763
Practice Address - Fax:727-821-0649
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME13362207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52779Medicare ID - Type Unspecified
D64415Medicare UPIN