Provider Demographics
NPI:1356394746
Name:NELSON, GARTH CHAD (MD)
Entity type:Individual
Prefix:DR
First Name:GARTH
Middle Name:CHAD
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 1:1020 LUKE ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4016
Mailing Address - Country:US
Mailing Address - Phone:970-493-2102
Mailing Address - Fax:970-493-9035
Practice Address - Street 1:1020 LUKE ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4016
Practice Address - Country:US
Practice Address - Phone:970-493-2102
Practice Address - Fax:970-493-9035
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38826207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE37914Medicare UPIN
CO66881Medicare ID - Type Unspecified