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Individual

IAN R NELSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
(260) 436-8585
Mailing address
P.O. BOX 2526, FORT WAYNE, IN 46801-2526
(260) 436-8686
(260) 436-8585

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01075426A
IN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
01075426A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201291590
IN
Enumeration date
07/15/2009
Last updated
11/03/2016
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