Individual
JEFFERY L NIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1563 E DOROTHY LN, KETTERING, OH 45429-3897
(937) 296-2853
Mailing address
1563 E DOROTHY LN, SUITE 101, KETTERING, OH 45429-3897
(937) 286-2953
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35-086065
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2560812
—
OH
01
—
P00225464
MCR RR
OH
Enumeration date
07/17/2006
Last updated
03/22/2019
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