Provider Demographics
NPI:1982886701
Name:PIERCE B NELSON DPM INC
Entity Type:Organization
Organization Name:PIERCE B NELSON DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:510-351-7552
Mailing Address - Street 1:13847 E 14TH STREET
Mailing Address - Street 2:STE 210
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2626
Mailing Address - Country:US
Mailing Address - Phone:510-351-7552
Mailing Address - Fax:510-351-6009
Practice Address - Street 1:13847 E 14TH ST
Practice Address - Street 2:STE 210
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2626
Practice Address - Country:US
Practice Address - Phone:510-351-7552
Practice Address - Fax:510-351-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2453213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty