Provider Demographics
NPI:1669695805
Name:NELSON, ANTHONY CARL (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CARL
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:201 N MAYFAIR RD FL 2
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4216
Mailing Address - Country:US
Mailing Address - Phone:414-874-4870
Mailing Address - Fax:414-874-4899
Practice Address - Street 1:201 N MAYFAIR RD FL 2
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4216
Practice Address - Country:US
Practice Address - Phone:414-874-4870
Practice Address - Fax:414-874-4899
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI52337-20208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery