Individual
JOEL NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
(812) 330-3688
(812) 355-3270
Mailing address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
(812) 330-3688
(812) 355-3270
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
01035192
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000300090
BLUE CROSS PROVIDER NO.
IN
01
—
01035192
IN STATE LICENSE NUMBER
IN
05
—
200059630
—
IN
Enumeration date
07/15/2005
Last updated
11/02/2016
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