Provider Demographics
NPI:1609803774
Name:NELSON, PERRY VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:VINCENT
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:PEACEHEALTH HOSPITAL MEDICINE
Mailing Address - Street 2:3377 RIVERBEND DRIVE
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-8803
Mailing Address - Country:US
Mailing Address - Phone:412-226-3893
Mailing Address - Fax:541-222-6385
Practice Address - Street 1:PEACEHEALTH HOSPITAL MEDICINE
Practice Address - Street 2:3377 RIVERBEND DRIVE
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8803
Practice Address - Country:US
Practice Address - Phone:412-226-3893
Practice Address - Fax:541-222-6385
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00010207R00000X
ORMD24573208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278100Medicaid
NC1609803774Medicaid
SCNC2126Medicaid
NCNCB384BMedicare PIN