Provider Demographics
NPI:1386753895
Name:NELSON, THOMAS ERL (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ERL
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5650
Practice Address - Street 1:6567 E CARONDELET DR STE 415
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6157
Practice Address - Country:US
Practice Address - Phone:520-887-7700
Practice Address - Fax:520-849-5735
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2020-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ56958207X00000X
MN32898207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
900625OtherMEDICA
190J2NEOtherBLUECROSS BLUESHIELD
140144E948OtherUCARE
96999102573OtherPREFERREDONE
MN751197300Medicaid
82707400OtherWISC MEDICAID
HP31501OtherHEALTHPARTNERS