Provider Demographics
NPI:1487726246
Name:NELSON, DAVID WESLEY JR (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WESLEY
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6464 SW BORLAND ROAD SUITE A4
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8854
Mailing Address - Country:US
Mailing Address - Phone:503-692-5737
Mailing Address - Fax:503-692-5307
Practice Address - Street 1:19300 SW 65TH
Practice Address - Street 2:LEGACY MERIDIAN PARK HOSPITAL
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8854
Practice Address - Country:US
Practice Address - Phone:503-692-5737
Practice Address - Fax:503-692-5307
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD143082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022272Medicaid
E35444Medicare UPIN
OR022272Medicaid