Provider Demographics
NPI:1427121904
Name:STEVEN L NELSON, M.D.INC
Entity type:Organization
Organization Name:STEVEN L NELSON, M.D.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-842-1293
Mailing Address - Street 1:PO BOX 1066
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-1066
Mailing Address - Country:US
Mailing Address - Phone:530-842-1293
Mailing Address - Fax:530-842-4822
Practice Address - Street 1:814 N MAIN ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-2538
Practice Address - Country:US
Practice Address - Phone:530-842-1293
Practice Address - Fax:530-842-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA756021983OtherRAILROAD MEDICARE NUMBER
CAGR0015870Medicaid
CAZZZ93853ZMedicare ID - Type Unspecified