Provider Demographics
NPI:1841686029
Name:NEISEN, AARON (DO)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:NEISEN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:LA BELLE
Mailing Address - State:MO
Mailing Address - Zip Code:63447-2092
Mailing Address - Country:US
Mailing Address - Phone:660-213-3245
Mailing Address - Fax:
Practice Address - Street 1:1000 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:LA BELLE
Practice Address - State:MO
Practice Address - Zip Code:63447-2092
Practice Address - Country:US
Practice Address - Phone:660-213-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05232207Q00000X
MO2017030003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine