Provider Demographics
NPI:1487735098
Name:ROY G. NELSON MD PC
Entity type:Organization
Organization Name:ROY G. NELSON MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:GUNNAR
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:303-673-9001
Mailing Address - Street 1:90 HEALTH PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9757
Mailing Address - Country:US
Mailing Address - Phone:303-673-9001
Mailing Address - Fax:
Practice Address - Street 1:90 HEALTH PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9757
Practice Address - Country:US
Practice Address - Phone:303-673-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO237812080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01237817Medicaid
COA47796Medicare UPIN