Individual
DR. DALLAS LEE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1000 SOUTH AVE, BOX 58, ROCHESTER, NY 14620-2733
(585) 341-0255
Mailing address
76 BENTON ST, ROCHESTER, NY 14620-2323
(585) 242-9399
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
223415
NY
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
223415
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025343361
—
NY
01
—
1391568J
PREFERRED CARE
NY
01
—
P010223415
BLUE CHOICE
NY
01
—
P020223415
BLUE SHIELD
NY
Enumeration date
05/19/2006
Last updated
07/05/2023
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