Individual
MATTHEW R NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
2375 E SUNNYSIDE RD STE J, IDAHO FALLS, ID 83404-8281
(208) 522-7246
(208) 529-2620
Mailing address
2375 E SUNNYSIDE RD, SUITE J, IDAHO FALLS, ID 83404-8280
(208) 522-7246
(208) 529-2620
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA540
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807285000
—
ID
Enumeration date
05/12/2006
Last updated
10/15/2014
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