Provider Demographics
NPI:1730524315
Name:NELSON, STEPHEN JOHN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOHN
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 968
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33846-0968
Mailing Address - Country:US
Mailing Address - Phone:863-298-4600
Mailing Address - Fax:863-298-5264
Practice Address - Street 1:1021 JIM KEENE BLVD
Practice Address - Street 2:DISTRICT 10 MEDICAL EXAMINER
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-8010
Practice Address - Country:US
Practice Address - Phone:863-298-4600
Practice Address - Fax:863-298-5264
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54490207ZF0201X, 207ZN0500X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology