Individual
NELS WALLACE THORDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
499 S GLOSTER ST STE G1, TUPELO, MS 38801-5539
(662) 377-2663
Mailing address
499 S GLOSTER ST # G1, TUPELO, MS 38801-5539
(662) 377-2663
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
18527
MS
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
18527
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01573566
—
MS
Enumeration date
01/25/2006
Last updated
01/26/2023
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