Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | D-3420-OS | ID |
NPI | 1376593640 |
---|---|
Provider Name | Dr. Eric Webb Nelson |
First Address | Boise, ID 83702-2026 |
Second Address | Boise, ID 83702-2026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 16/04/2018 |