Provider Demographics
NPI:1891743464
Name:NELSON, DANNY A (MD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:A
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13943 N 91ST AVE
Mailing Address - Street 2:C-101
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3687
Mailing Address - Country:US
Mailing Address - Phone:623-972-3992
Mailing Address - Fax:623-974-9351
Practice Address - Street 1:13943 N 91ST AVE
Practice Address - Street 2:C-101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3687
Practice Address - Country:US
Practice Address - Phone:623-760-9449
Practice Address - Fax:623-974-9351
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ17497207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1891743464OtherAHCCCS
AZAZ0323590OtherBLUE CROSS BLUE SHIELD
AZ1510096OtherUNITED HEALTHCARE
AZ0839376OtherAETNA
AZ1Z3196OtherHEALTH NET
AZ001510096OtherEVERCARE
WCHTR02OtherMEDICARE ID
AZ070003070OtherRAILROAD MEDICARE
AZ347551Medicaid
AZ188961600OtherDEPT OF LABOR WORK COMP
AZ1891743464OtherAHCCCS
AZAZ0323590OtherBLUE CROSS BLUE SHIELD