Provider Demographics
NPI:1336173483
Name:NELSON, DOUGLAS L (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
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 1:13904 MONROES BUSINESS PARK
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-6370
Mailing Address - Country:US
Mailing Address - Phone:727-799-9060
Mailing Address - Fax:727-799-5315
Practice Address - Street 1:13904 MONROES BUSINESS PARK
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-6370
Practice Address - Country:US
Practice Address - Phone:727-799-9060
Practice Address - Fax:727-799-5315
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37754AMedicare ID - Type Unspecified
FLI06766Medicare UPIN