Provider Demographics
NPI:1760407944
Name:NELSON, RONALD ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ANDREW
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 1:515 HIGHLAND TER
Mailing Address - Street 2:SUITE A
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2472
Mailing Address - Country:US
Mailing Address - Phone:615-904-2010
Mailing Address - Fax:615-904-6285
Practice Address - Street 1:515 HIGHLAND TER
Practice Address - Street 2:SUITE A
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2472
Practice Address - Country:US
Practice Address - Phone:615-904-2010
Practice Address - Fax:615-904-6285
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000031447207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4084329OtherBLUE CROSS BLUE SHIELD
TN3871904Medicaid
TN3871904Medicare PIN
TNH56086Medicare UPIN