Provider Demographics
NPI:1932127404
Name:NELSON, ELLIOT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:C
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:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-286-1700
Mailing Address - Fax:314-970-9094
Practice Address - Street 1:600 S TAYLOR AVE
Practice Address - Street 2:DEPT PSYCHIATRY, STE 122
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1035
Practice Address - Country:US
Practice Address - Phone:314-286-1700
Practice Address - Fax:314-970-9094
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1K272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202837902Medicaid
MO202837902Medicaid
MO044010213Medicare PIN
IL$$$$$$$$$Medicaid