Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 188187-1205 | UT |
NPI | 1033299425 |
---|---|
Provider Name | Douglas Scott Nelson |
First Address | Salt Lake City, UT 84158-1100 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 30/11/2021 |