Provider Demographics
NPI:1750318697
Name:NELSON, BRIAN W (MD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:W
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3050 CENTRE POINTE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-639-9150
Mailing Address - Fax:651-639-9153
Practice Address - Street 1:3050 CENTRE POINTE DR
Practice Address - Street 2:STE 200
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113
Practice Address - Country:US
Practice Address - Phone:651-639-9150
Practice Address - Fax:651-639-9153
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN26599207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN517770700Medicaid
A03111Medicare UPIN