Basic Information
| Provider Information | |||||||||
| NPI: | 1386753895 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | ERL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6465 WAYZATA BLVD | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554261728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525125600 | ||||||||
| FaxNumber: | 9525125650 | ||||||||
| Practice Location | |||||||||
| Address1: | 6567 E CARONDELET DR STE 415 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857106157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208877700 | ||||||||
| FaxNumber: | 5208495735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 05/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 56958 | AZ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 32898 | MN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 900625 | 01 | MEDICA | OTHER | 190J2NE | 01 | BLUECROSS BLUESHIELD | OTHER | 140144E948 | 01 | UCARE | OTHER | 96999102573 | 01 | PREFERREDONE | OTHER | 751197300 | 05 | MN | MEDICAID | 82707400 | 01 | WISC MEDICAID | OTHER | HP31501 | 01 | HEALTHPARTNERS | OTHER |