Individual
GREGORY N NELSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12349 DE PAUL DR STE 100, BRIDGETON, MO 63044-2512
(314) 291-7900
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
49237
AZ
207X00000X
Orthopaedic Surgery Physician
Primary
2017006909
MO
207X00000X
Orthopaedic Surgery Physician
25MA09367900
NJ
207X00000X
Orthopaedic Surgery Physician
49237
AZ
207X00000X
Orthopaedic Surgery Physician
MD448629
PA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
49237
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AZ
Enumeration date
08/20/2008
Last updated
11/19/2020
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