Individual
DR. MATTHEW JACOB NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1907 S BROADWAY AVE STE 101, BOISE, ID 83706-4229
(208) 345-1222
(208) 345-1261
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-10913
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808083100
—
ID
Enumeration date
06/20/2008
Last updated
08/27/2019
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