Provider Demographics
NPI:1841230927
Name:NELSON, MILES J (MD)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:J
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 2505
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-2505
Mailing Address - Country:US
Mailing Address - Phone:888-828-3197
Mailing Address - Fax:
Practice Address - Street 1:10501 GOLF COURSE RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5019
Practice Address - Country:US
Practice Address - Phone:615-928-6268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93-346207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
14924OtherPRESBY- TERIAN
301060OtherRIO PRIMARY CARE
NM000T5696Medicaid
6609OtherLOVELACE
6609OtherLOVELACE
$$$$$$$$$RMedicare PIN
P00114953Medicare ID - Type UnspecifiedRAILROAD MEDICARE