Provider Demographics
NPI:1881683696
Name:NELSON, BRIAN DEANE (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DEANE
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 1:1200 SIXTH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-251-2700
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:6401 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2104
Practice Address - Country:US
Practice Address - Phone:952-924-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40084207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
6D053CEOtherBLUE CROSS BLUE SHIELD
313K7NEOtherBLUE CROSS BLUE SHIELD
106868OtherU-CARE
MN400219900Medicaid
P00174824OtherRR MEDICARE
1033658OtherARAZ GROUP/AMERICA'S PPO
0407013OtherMEDICA HEALTH PLANS
1012483OtherPREFERRED ONE
400219900OtherMEDICAL ASSISTANCE
C11369OtherRR MEDICARE
HP20578OtherHEALTH PARTNERS
106868OtherU-CARE
313K7NEOtherBLUE CROSS BLUE SHIELD