Provider Demographics
NPI:1417183914
Name:NELSON, ERIC MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:MICHAEL
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34310
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-0310
Mailing Address - Country:US
Mailing Address - Phone:402-778-9738
Mailing Address - Fax:402-334-2849
Practice Address - Street 1:6901 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1709
Practice Address - Country:US
Practice Address - Phone:402-778-9738
Practice Address - Fax:402-334-2849
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25085207L00000X
IA38393207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055043813Medicaid