Provider Demographics
NPI:1760581664
Name:LOCSIN, NESTOR M JR (MD)
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:M
Last Name:LOCSIN
Suffix:JR
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 1:333 SMITH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2344
Mailing Address - Country:US
Mailing Address - Phone:612-262-6611
Mailing Address - Fax:
Practice Address - Street 1:333 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2344
Practice Address - Country:US
Practice Address - Phone:612-262-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04-06093OtherMEDICA
MN233695200Medicaid
MN1035316OtherPREFERREDONE
MN513G2LOOtherBLUECROSSBLUESHIELD
ND10703Medicaid
MNHP62489OtherHEALTHPARTNERS
MN171962OtherUCAREMN
NE41091744413Medicaid
MNHP62489OtherHEALTHPARTNERS
MN110014407Medicare PIN