Nelson, Brent D

Nelson, Brent D is an individual health care provider with primary practice located at 190 E Bannock St , Boise ID 83712-6241. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology is his primary health care specialty. Nelson, Brent D can be contacted via phone (208) 381-2094.

Contact Information

Primary practice address
190 E Bannock St Boise ID 83712-6241
Phone: (208) 381-2094
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X M6231 Idaho
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X M6231 Idaho

Profile Details

NPI number 1740224310
LBN Legal business name Nelson, Brent D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2006
Last updated Oct 22nd, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740224310 NPPES
Idaho MEDICAID 003858900

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