Provider Demographics
NPI:1942540158
Name:NELSON, CLIFFORD CONRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:CONRAD
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 1:13309 SE 84TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6924
Mailing Address - Country:US
Mailing Address - Phone:971-673-8200
Mailing Address - Fax:
Practice Address - Street 1:13309 SE 84TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6924
Practice Address - Country:US
Practice Address - Phone:971-673-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16575207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology