Provider Demographics
NPI:1659366466
Name:NELSON, BRYAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:E
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 1:315 75TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3201
Mailing Address - Country:US
Mailing Address - Phone:941-761-1616
Mailing Address - Fax:941-761-3807
Practice Address - Street 1:315 75TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3201
Practice Address - Country:US
Practice Address - Phone:941-761-1616
Practice Address - Fax:941-761-3807
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265421100Medicaid
FL080191006OtherRAIL ROAD MEDICARE
FL81931OtherBCBS
FL81931OtherBCBS
FL265421100Medicaid