Provider Demographics
NPI:1962479766
Name:NELSON, DAYNE MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:DAYNE
Middle Name:MATTHEW
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:MCHJ SU
Mailing Address - Street 2:9040 A. REID STREET
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1100
Mailing Address - Country:US
Mailing Address - Phone:253-968-2300
Mailing Address - Fax:
Practice Address - Street 1:2352 MEADOWS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8419
Practice Address - Country:US
Practice Address - Phone:720-455-0670
Practice Address - Fax:720-455-0671
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0054391208800000X
CODR.0059341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty