Individual
LARS SPENCER NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1890 LPGA BLVD, SUITE 250, DAYTONA BEACH, FL 32117-7130
(386) 274-0250
(386) 274-0268
Mailing address
11945 SAN JOSE BLVD, SUITE 300, JACKSONVILLE, FL 32223-1613
(904) 396-1725
(904) 399-1717
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME123398
FL
2086S0127X
Trauma Surgery Physician
ME123398
FL
390200000X
Student in an Organized Health Care Education/Training Program
ME123398
FL
Other
Enumeration date
07/14/2009
Last updated
01/10/2017
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