Active NPI
Christopher G Nelson, M.D.
- Dermatology Physician
- Tampa, FL
National Provider Identifier
1477541076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- ME19963
- Practice address
- 12901 Bruce B Downs Blvd
MDC 79
Tampa, FL 33612-4742 - Phone
- (813) 974-2201
- NPI assigned
- Oct 9, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | ME19963 | FL | Primary |
Addresses
Primary practice location
12901 Bruce B Downs Blvd
MDC 79
Tampa, FL 33612-4742
Mailing address
PO Box 917770
Orlando, FL 32891-0001
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 78995 | Other | FL | BLUE CROSS BLUE SHIELD |
| 003538600 | Medicaid | FL |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313020800000",
"number": "1477541076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 917770",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328910001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12901 BRUCE B DOWNS BLVD",
"address_2": "MDC 79",
"city": "TAMPA",
"state": "FL",
"postal_code": "336124742",
"telephone_number": "813-974-2201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "CHRISTOPHER",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-09",
"last_updated": "2011-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "FL",
"license": "ME19963",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "78995",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003538600",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.