Provider Demographics
NPI:1245341601
Name:NELSON, MARK C (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9834 GENESEE AVENUE
Mailing Address - Street 2:SUITE 223
Mailing Address - City:LAJOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-777-7917
Mailing Address - Fax:858-703-5048
Practice Address - Street 1:9834 GENESEE AVENUE
Practice Address - Street 2:SUITE 223
Practice Address - City:LAJOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-777-7917
Practice Address - Fax:858-703-5048
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-02-02
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Provider Licenses
StateLicense IDTaxonomies
CAA80416207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH75303Medicare UPIN