Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 56 | WY |
NPI | 1184785107 |
---|---|
Provider Name | John H Nelson |
First Address | Casper, WY 82601-2777 |
Second Address | Casper, WY 82601-2777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T84759 | (02) | WY |