Provider Demographics
NPI:1740285220
Name:NELSON, ROSS (DPM)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 WHITE BEAR AVE N
Mailing Address - Street 2:SUITE A
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5136
Mailing Address - Country:US
Mailing Address - Phone:651-770-3891
Mailing Address - Fax:651-748-3117
Practice Address - Street 1:2599 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-5171
Practice Address - Country:US
Practice Address - Phone:651-770-3891
Practice Address - Fax:651-748-3117
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN468213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN294325500Medicaid
MN480000318Medicare PIN
MN294325500Medicaid
MNU44500Medicare UPIN