Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 164038 | NY |
N | 207R00000X | Internist | 164038 | NY |
N | 111NI0900X | Internist | 164038 | NY |
NPI | 1245209634 |
---|---|
Provider Name | Dr. Gary Robert Nelson |
First Address | Orchard Park, NY 14127-1538 |
Second Address | Orchard Park, NY 14127-1538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 19/11/2018 |