Individual
IAN MICHAEL NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
307 BOATNER RD STE 114, EGLIN AFB, FL 32542-1302
(850) 883-8600
Mailing address
307 BOATNER RD STE 114, EGLIN AFB, FL 32542-1302
(850) 883-8600
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME135574
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113673900
—
FL
01
—
EG8TR
BCBS
FL
01
—
PE355
MEDICARE PTAN OHRI
FL
01
—
PS139
MEDICARE PTAN OHMG
FL
Enumeration date
04/21/2016
Last updated
03/28/2023
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