| Gregory Clifford Nelson, PA | |
|
101 Bodin Cir, Travis Afb, CA 94535-1809 | |
| (707) 423-7611 | |
| Not Available |
| Full Name | Gregory Clifford Nelson |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 101 Bodin Cir, Travis Afb, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396142311 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 1121110 (California) | Primary |
| Entity Name | Kenneth P Martinez MD a Medical Corp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1255537957 PECOS PAC ID: 9133115629 Enrollment ID: O20040421000850 |
| Mailing Address | Practice Location Address |
|---|---|
| Gregory Clifford Nelson, PA 2713 Manzano, Mission Viejo, CA 92692 Ph: (949) 412-7695 | Gregory Clifford Nelson, PA 101 Bodin Cir, Travis Afb, CA 94535-1809 Ph: (707) 423-7611 |
Deanna Le, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 60 Mdg/omrs, 101 Bodin Circle, Travis Afb, CA 94535 Phone: 707-413-7295 |
Susana Quezada Awad, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 60 Mdg/hcos, 101 Bodic Cir, Travis Afb, CA 94535 Phone: 707-423-3964 |
Heidi Lynn Shelstad, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 101 Bodin Cir, Travis Afb, CA 94535 Phone: 707-423-3825 |
Austin Ryder Podratz, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 101 Bodin Cir, Travis Afb, CA 94535 Phone: 707-423-3000 |
Kamille Resetz, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 531 Waldron St Ste D, Travis Afb, CA 94535 Phone: 707-424-3812 |
Shawn M Hannah, Physician Assistant Medicare: Medicare Enrolled Practice Location: 60 Mdg/sgcs, 101 Bodin Circle, Travis Afb, CA 94535 Phone: 707-423-3216 |
Adriane Glidewell, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 101 Bodin Cir, Travis Afb, CA 94535 Phone: 707-423-7295 |