Provider Demographics
NPI:1417040890
Name:NELSON, JOHN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12035
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-0035
Mailing Address - Country:US
Mailing Address - Phone:913-599-3800
Mailing Address - Fax:913-599-3854
Practice Address - Street 1:10550 QUIVIRA RD
Practice Address - Street 2:SUITE 335
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2306
Practice Address - Country:US
Practice Address - Phone:913-599-3800
Practice Address - Fax:913-599-3854
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0417628207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201237914Medicaid
MO1417040890Medicaid
07794141OtherBCBS KANSAS CITY
KS058659OtherBCBS KANSAS
KS100190940BMedicaid
MO201237914Medicaid
07794141OtherBCBS KANSAS CITY
MO1417040890Medicaid
290002688Medicare ID - Type UnspecifiedRAILROAD
KS058659Medicare ID - Type UnspecifiedKANSAS