Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 45712 | WI |
NPI | 1003868704 |
---|---|
Provider Name | Dr. Philip A Nelson |
First Address | Milwaukee, WI 53226-3421 |
Second Address | Milwaukee, WI 53226-3421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34394500 | (05) | WI |
H90739 | (02) |