Provider Demographics
NPI:1316152713
Name:STEPHEN G. NELSON, M.D., PA
Entity type:Organization
Organization Name:STEPHEN G. NELSON, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:ZAMORE
Authorized Official - Last Name:WEINBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-525-2161
Mailing Address - Street 1:5601 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-1205
Mailing Address - Country:US
Mailing Address - Phone:727-525-2161
Mailing Address - Fax:727-527-1968
Practice Address - Street 1:5601 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-1205
Practice Address - Country:US
Practice Address - Phone:727-525-2161
Practice Address - Fax:727-527-1968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty