Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 25708 | TN |
Y | 208000000X | Pediatrician | 25708 | TN |
NPI | 1336149558 |
---|---|
Provider Name | Dr. Richard A Nelson |
First Address | Memphis, TN 38104-5905 |
Second Address | Memphis, TN 38127-5977 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 21/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E64595 | (02) | TN |