Provider Demographics
NPI:1861497125
Name:NELSON, STEVEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
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 1066
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-1066
Mailing Address - Country:US
Mailing Address - Phone:530-842-1293
Mailing Address - Fax:530-842-9054
Practice Address - Street 1:814 N MAIN ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-2538
Practice Address - Country:US
Practice Address - Phone:530-842-1293
Practice Address - Fax:530-842-9054
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41582208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR00158705Medicaid
CAZZZ93853ZMedicare ID - Type UnspecifiedMEDICARE NUMBER
CAGR00158705Medicaid