Provider Demographics
NPI:1104960905
Name:NELSON, GERALD E
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:E
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9285 HEPBURN ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126
Mailing Address - Country:US
Mailing Address - Phone:720-348-4508
Mailing Address - Fax:
Practice Address - Street 1:9285 HEPBURN ST
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2262
Practice Address - Country:US
Practice Address - Phone:720-348-4508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28249207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
004373OtherKAISER-COMMERCIAL NUMBER
CO01282490Medicaid
COCOA104178Medicare PIN
004373OtherKAISER-COMMERCIAL NUMBER
COE98730Medicare UPIN