Provider Demographics
NPI:1578518148
Name:NELSON, RICHARD EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EUGENE
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 1:9233 WARD PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3366
Mailing Address - Country:US
Mailing Address - Phone:816-389-6030
Mailing Address - Fax:816-389-6034
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:CARDIOTHORACIC ANESTHESIA DEPT
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-389-6030
Practice Address - Fax:816-389-6034
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9B92207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO100119090CMedicaid
MO201773157Medicaid
MO050088894OtherMO RR MEDICARE NUMBER
MO09304051OtherMO BCBS PROVIDER NUMBER
MO000282OtherMO FHP PROVIDER NUMBER
MO09304051OtherMO BCBS PROVIDER NUMBER
MO000282OtherMO FHP PROVIDER NUMBER