Active NPI
Alvah J Nelson III, M.D.
- Radiation Oncology Physician
- Little Rock, AR
National Provider Identifier
1437383726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- License
- R-2246
- Practice address
- 12105 Fairway Dr
Little Rock, AR 72212-3428 - Phone
- (501) 225-3725
- NPI assigned
- May 14, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | R-2246 | AR | Primary |
Addresses
Primary practice location
12105 Fairway Dr
Little Rock, AR 72212-3428
Mailing address
12105 Fairway Dr
Little Rock, AR 72212-3428
Phone (501) 225-3725
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104653001 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-2246 | AR | MD | Radiation Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242259200000",
"number": "1437383726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12105 FAIRWAY DR",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722123428",
"telephone_number": "501-225-3725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12105 FAIRWAY DR",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722123428",
"telephone_number": "501-225-3725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "ALVAH",
"middle_name": "J",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-14",
"last_updated": "2009-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "",
"desc": "Radiology, Radiation Oncology",
"state": "AR",
"license": "R-2246",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104653001",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.