Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO0002554 | FL |
Y | 222Z00000X | Podiatrist | PO0002554 | FL |
NPI | 1053313783 |
---|---|
Provider Name | Dr. Robert Samuel Nelson |
First Address | Coral Springs, FL 33071-6149 |
Second Address | Coral Springs, FL 33071-6149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 21/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
390294301 | (05) | FL |
65449 | MEDICARE ID (01) | FL |
U60936 | (02) | FL |