Provider Demographics
NPI:1164486908
Name:NELSON, STEVEN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CHRISTOPHER
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 WESTWOODS DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1181
Mailing Address - Country:US
Mailing Address - Phone:816-781-4740
Mailing Address - Fax:816-781-0971
Practice Address - Street 1:140 WESTWOODS DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1181
Practice Address - Country:US
Practice Address - Phone:816-781-4740
Practice Address - Fax:816-781-0971
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO146128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO146128OtherSTATE LICENSE NUMBER
A15B185AMedicare ID - Type Unspecified
MO146128OtherSTATE LICENSE NUMBER