Provider Demographics
NPI:1962680108
Name:DONALD R NELSON MD PC
Entity Type:Organization
Organization Name:DONALD R NELSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARLUENE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:LANGEJANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-855-4128
Mailing Address - Street 1:1945 MESQUITE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5889
Mailing Address - Country:US
Mailing Address - Phone:928-855-4128
Mailing Address - Fax:928-855-7539
Practice Address - Street 1:1945 MESQUITE AVE STE A
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5889
Practice Address - Country:US
Practice Address - Phone:928-855-4128
Practice Address - Fax:928-855-7539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05491207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ219940Medicaid
AZ219940Medicaid
AZZ64878Medicare PIN