Provider Demographics
NPI:1689796294
Name:USRY, NELSON G (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:G
Last Name:USRY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5551 WINGHAVEN BLVD
Mailing Address - Street 2:STE 142
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3617
Mailing Address - Country:US
Mailing Address - Phone:636-695-2510
Mailing Address - Fax:636-695-2512
Practice Address - Street 1:5551 WINGHAVEN BLVD
Practice Address - Street 2:STE 142
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3617
Practice Address - Country:US
Practice Address - Phone:636-695-2510
Practice Address - Fax:636-695-2512
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2015-02-11
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Provider Licenses
StateLicense IDTaxonomies
MO2004016761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO312684703Medicare PIN