Provider Demographics
NPI:1407835085
Name:NIELSEN, ROBERT C (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-8689
Mailing Address - Country:US
Mailing Address - Phone:573-302-7490
Mailing Address - Fax:573-302-7895
Practice Address - Street 1:3870 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-8689
Practice Address - Country:US
Practice Address - Phone:573-302-7490
Practice Address - Fax:573-302-7895
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO103086207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO246670707Medicaid
MOF60875Medicare UPIN
MO246670707Medicaid