Provider Demographics
NPI:1487700878
Name:GLENN E NELSON DPM LLC
Entity type:Organization
Organization Name:GLENN E NELSON DPM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:520-886-1176
Mailing Address - Street 1:2308 N ROSEMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2139
Mailing Address - Country:US
Mailing Address - Phone:520-886-1172
Mailing Address - Fax:520-290-8894
Practice Address - Street 1:2308 N ROSEMONT BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2139
Practice Address - Country:US
Practice Address - Phone:520-886-1172
Practice Address - Fax:520-290-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC9300OtherRAILROAD MEDICARE
AZ701004Medicaid
AZZ100278Medicare PIN
AZDC9300OtherRAILROAD MEDICARE