Glenn Nelson, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

12814 Issued in AL

Practice address

100 Memorial Hospital Dr
Ste 1D
Mobile, AL 36608-1194

Phone

(251) 342-0030

Fax

(251) 380-0065

NPI assigned

Nov 10, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1891776449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MEMORIAL HOSPITAL DR",
            "address_2": "STE 1D",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366081194",
            "telephone_number": "251-460-0326",
            "fax_number": "251-460-2846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEMORIAL HOSPITAL DR",
            "address_2": "STE 1D",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366081194",
            "telephone_number": "251-342-0030",
            "fax_number": "251-380-0065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AL",
            "license": "12814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009939527",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000082122",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009912316",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Patrick Neilan, P.A.
• Billie-Rae Nelson
• Brea Nelson
• Candice Marie Nelson, APRN, FNP-C
• Deborah E Nelson, RPT
• Katie Nelson
• Mary Nelson
• Megan Nelson, DO
• Mollyanna Nelson, PT
• Phillip Nelson

• Anatomic Pathology & Clinical Pathology Physician in Mobile, AL
• Providers in Mobile, AL by specialty
• Anatomic Pathology & Clinical Pathology Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.