Provider Demographics
NPI:1013950708
Name:NELSON, JEFFERSON EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:EDWARD
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:PO BOX 160097
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-0097
Mailing Address - Country:US
Mailing Address - Phone:512-422-6067
Mailing Address - Fax:
Practice Address - Street 1:1441 CONSTITUTION BLVD, BUILDING 400
Practice Address - Street 2:SUITE 200
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3127
Practice Address - Country:US
Practice Address - Phone:831-796-1704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00190322084P0800X
TXE10832084P0800X
CO190322084P0800X
CAC1523982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC19829Medicare UPIN
TX86V451Medicare PIN