Provider Demographics
NPI:1962420463
Name:NELSON, DONALD M (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:M
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8064
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-8181
Mailing Address - Fax:314-747-1256
Practice Address - Street 1:4901 FOREST PARK AVE STE 710
Practice Address - Street 2:STE 710
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1402
Practice Address - Country:US
Practice Address - Phone:314-454-8181
Practice Address - Fax:314-747-1429
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR9013207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201819208Medicaid
ILENROLLEDMedicaid
MO160052103Medicare PIN
MO010010217Medicaid