Individual
DR. DONALD GENE NORDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 BUCKWALTER PLACE BLVD STE 150, BLUFFTON, SC 29910-5023
(843) 836-7120
Mailing address
836 E 65TH ST STE 22, SAVANNAH, GA 31405-4493
(912) 819-2146
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
32028
IA
2085R0001X
Radiation Oncology Physician
70913
WI
2085R0202X
Diagnostic Radiology Physician
22742
MN
2085R0202X
Diagnostic Radiology Physician
Primary
83205
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1990903
—
IA
01
—
49561
IA BLUESHIELD
IA
05
—
832059
—
SC
01
—
920005055
RR MEDICARE
IA
Enumeration date
08/10/2005
Last updated
08/26/2024
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