Provider Demographics
NPI:1801260096
Name:NELSON, GERALD DALE (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DALE
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 1:9403 CROSS CREEK ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-4086
Mailing Address - Country:US
Mailing Address - Phone:316-630-8594
Mailing Address - Fax:970-879-5047
Practice Address - Street 1:9403 CROSS CREEK ST (RETIRED)
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-4086
Practice Address - Country:US
Practice Address - Phone:316-630-8594
Practice Address - Fax:970-879-5047
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-12590208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery