Dr. Charles David Ettelson
Plastic and Reconstructive Surgery
730 Audubon Dr
Saint Louis
, Missouri 63105-2906
Dr. Charles David Ettelson
Plastic and Reconstructive Surgery
730 Audubon Dr
Saint Louis
, Missouri 63105-2906
(314) 324-7605
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About
Features
Specialties
- Plastic and Reconstructive Surgery
Languages spoken
- English
Location
First Address
- Dr. Charles David Ettelson
- 730 Audubon Dr
- Saint Louis, MO
- Zip : 63105-2906
- Phone : (314) 324-7605
Second Address
- Dr. Charles David Ettelson
- 730 Audubon Dr
- Saint Louis, MO
- Zip : 63105-2906
- Phone : (314) 324-7605
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2086S0122X | Plastic and Reconstructive Surgery | R9446 | MO |
National Provider Identifier
| NPI | 1255332904 |
|---|---|
| Provider Name | Dr. Charles David Ettelson |
| First Address | Saint Louis, MO 63105-2906 |
| Second Address | Saint Louis, MO 63105-2906 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 03/08/2005 |
| Last Update Date | 02/07/2013 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| AEO957 | (02) | MO |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.