Individual
DEREK E NEILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1920 E CAMBRIDGE AVE STE 304, PHOENIX, AZ 85006
(602) 933-4363
(602) 933-2415
Mailing address
3200 E CAMELBACK RD STE 250, PHOENIX, AZ 85018-2327
(602) 933-1814
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
35-083650
OH
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
56355
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000224312
UNISON
OH
01
—
000000340115
ANTHEM
OH
01
—
000000529594
ANTHEM
OH
05
—
2499952
—
OH
01
—
363878
WELLCARE
OH
01
—
745996
BUCKEYE
OH
01
—
7841606
AETNA
OH
Enumeration date
07/09/2006
Last updated
07/10/2018
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