Individual
EVAN L NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 E MESCALERO RD, ROSWELL, NM 88201-6542
(575) 755-2272
(575) 622-3325
Mailing address
1112 N MAIN ST, ROSWELL, NM 88201-5010
(575) 627-4200
(575) 627-4212
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
87-381
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
330095YM5A
MEDICARE PTAN
NM
05
—
34684565
—
NM
Enumeration date
04/14/2006
Last updated
03/17/2018
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