Provider Demographics
NPI:1194090423
Name:SCOTT E NELSON MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:SCOTT E NELSON MD A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-445-3900
Mailing Address - Street 1:612 W DUARTE RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7602
Mailing Address - Country:US
Mailing Address - Phone:636-445-3900
Mailing Address - Fax:
Practice Address - Street 1:612 W DUARTE RD
Practice Address - Street 2:SUITE 404
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7602
Practice Address - Country:US
Practice Address - Phone:636-445-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG30870OtherMEDICARE PTAN NUMBER G30870
CAA91314Medicare UPIN