Provider Demographics
NPI:1942227442
Name:NELSON, PETER J (MD)
Entity Type:Individual
Prefix:
First Name:PETER
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 1:2605 BAUMGARTNER DR
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-8503
Mailing Address - Country:US
Mailing Address - Phone:608-781-1401
Mailing Address - Fax:
Practice Address - Street 1:2605 BAUMGARTNER DR
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-8503
Practice Address - Country:US
Practice Address - Phone:608-781-1401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22474-20207LH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN463770400Medicaid
MN154R6NEOtherBLUE CROSS BLUE SHIELD
WI30386200OtherMA
MN154R6NEOtherBLUE CROSS BLUE SHIELD
WI30386200OtherMA