Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 177029-1205 | UT |
NPI | 1972682540 |
---|---|
Provider Name | Raoul Devin Nelson |
First Address | Salt Lake City, UT 84141-3021 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 08/11/2021 |