Provider Demographics
NPI:1255541843
Name:NELSON, RICHARD T (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:NELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 MAPLECREST RD STE 10
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2799
Mailing Address - Country:US
Mailing Address - Phone:563-421-4620
Mailing Address - Fax:563-421-4625
Practice Address - Street 1:2535 MAPLECREST RD STE 10
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2799
Practice Address - Country:US
Practice Address - Phone:563-421-4620
Practice Address - Fax:563-421-4625
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3808207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine