Provider Demographics
NPI:1508847161
Name:NELSON, CHARLES GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:GREGORY
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C
Other - Middle Name:GREGORY
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 SW FRAZIER CIR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2800
Mailing Address - Country:US
Mailing Address - Phone:785-232-2044
Mailing Address - Fax:785-232-5567
Practice Address - Street 1:200 SW FRAZIER CIR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2800
Practice Address - Country:US
Practice Address - Phone:785-232-2044
Practice Address - Fax:785-232-5567
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0422064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E45961Medicare UPIN
KS20243NEMedicare ID - Type Unspecified