Doctor Name: | CORY NELSON |
NPI Number: | 1124339460 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | 5101018672 |
Business Practice Address: | 1157 N 300 W #201 Provo, UT - 846046124 |
Business Phone Number: | 8013571200 |
Business Fax Number: | |
Mailing Address: | 1577 W Wynview Ln, SOUTH JORDAN |
State: | UT |
Postal Code: | 840958480 |
Phone Number: | 8015439264 |
Fax Number: | |
NPI Enumeration Date: | 07/01/2010 |
NPI Last Update Date: | 05/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 5101018672 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |