Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2017006909 | MO |
N | 207X00000X | Orthopaedic Surgeon | 25MA09367900 | NJ |
N | 207X00000X | Orthopaedic Surgeon | 49237 | AZ |
N | 207X00000X | Orthopaedic Surgeon | MD448629 | PA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 49237 | AZ |
NPI | 1114174265 |
---|---|
Provider Name | Gregory N Nelson JR. |
First Address | Saint Louis, MO 63195-5534 |
Second Address | Bridgeton, MO 63044-2512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2008 |
Last Update Date | 19/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | AZ |