Provider Demographics
NPI:1891776449
Name:NELSON, GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 MEMORIAL HOSPITAL DR
Mailing Address - Street 2:STE 1D
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1194
Mailing Address - Country:US
Mailing Address - Phone:251-460-0326
Mailing Address - Fax:251-460-2846
Practice Address - Street 1:100 MEMORIAL HOSPITAL DR
Practice Address - Street 2:STE 1D
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1194
Practice Address - Country:US
Practice Address - Phone:251-342-0030
Practice Address - Fax:251-380-0065
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL12814207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009939527Medicaid
AL000082122Medicaid
AL009912316Medicaid
AL000082122Medicare PIN
AL009939527Medicaid