Individual
LAWRENCE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
36089481
IL
2086S0127X
Trauma Surgery Physician
Primary
036-089481
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4673170001
DMERC
IL
01
—
P00470671
RAILROAD MEDICARE
IL
Enumeration date
12/29/2005
Last updated
06/13/2008
Update your record
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