Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | IL |
NPI | 1003868787 |
---|---|
Provider Name | Dr. Douglas Dirk Nelson |
First Address | Chicago, IL 60616-2955 |
Second Address | Hometown, IL 60456-1133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 09/07/2007 |