Provider Demographics
NPI:1700886975
Name:NELSON, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2000 STADIUM WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2606
Mailing Address - Country:US
Mailing Address - Phone:323-428-6180
Mailing Address - Fax:213-202-6803
Practice Address - Street 1:2000 STADIUM WAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2606
Practice Address - Country:US
Practice Address - Phone:213-250-4200
Practice Address - Fax:213-250-3274
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60128207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G601280Medicaid
CAWG60128CMedicare ID - Type Unspecified
CAE47848Medicare UPIN