Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 39414 | CO |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 39414 | CO |
N | 207VG0400X | Gynecologist | DR.0039414 | CO |
NPI | 1619974318 |
---|---|
Provider Name | Dr. Brian S Nelson |
First Address | Longmont, CO 80501-3128 |
Second Address | Longmont, CO 80501-3128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 27/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01878751 | (05) | CO |
H43077 | (02) |