Provider Demographics
NPI:1750653143
Name:NELSON, RALPH ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:ARTHUR
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:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98353-0507
Mailing Address - Country:US
Mailing Address - Phone:360-621-8179
Mailing Address - Fax:
Practice Address - Street 1:2332 2ND AVE EAST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:WA
Practice Address - Zip Code:98366-8590
Practice Address - Country:US
Practice Address - Phone:360-621-8179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17760207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology