Provider Demographics
NPI:1184785107
Name:NELSON, JOHN H (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:NELSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2777
Mailing Address - Country:US
Mailing Address - Phone:307-266-4415
Mailing Address - Fax:307-472-4414
Practice Address - Street 1:1916 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2777
Practice Address - Country:US
Practice Address - Phone:307-266-4415
Practice Address - Fax:307-472-4414
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY56213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYT84759Medicare UPIN
WYW9538Medicare ID - Type Unspecified