DR. CHARLES DAVID ETTELSON (NPI# 1255332904) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255332904 |
| Entity Type | Individual |
| Full Name | DR. CHARLES DAVID ETTELSON |
| Credential | M.D. |
| Practice Address |
730 Audubon Dr Saint Louis MO 63105-2906 |
| Practice Telephone | 3143247605 |
| Mailing Telephone | 3143247605 |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2013-07-02 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
R9446 | MO | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598165375 | Charles Ettelson | Physician Assistant | 1601 E 19th Ave Ste 3300, Denver, CO 80218-1239 | 2014-08-28 |
| Street Address |
730 AUDUBON DR |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63105-2906 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861016545 | Amy Piontek | Registered Nurse | Habif Health and Wellness Center, 6643 Shepley Drive, St. Louis, MO 63105 | 2020-05-29 |
| 1427520634 | Justin Kelly | Chiropractor | 8011 Maryland Avenue, St. Louis, MO 63105 | 2018-12-28 |
| 1720576663 | St. Louis Center for Cognitive Health, LLC | Clinic/Center | 7711 Bonhomme Ave Ste 350, Clayton, MO 63105 | 2018-04-26 |
| 1457849317 | A Storied Life Counseling LLC | Social Worker | 8000 Bonhomme Ave Ste 321, Clayton, MO 63105 | 2018-04-26 |
| 1669984142 | Peter Bogart | Counselor | 7710 Carondelet, Suite #204, Saint Louis, MO 63105 | 2017-10-24 |
| 1356891162 | Medical West Respiratory Pharmacy, LLC | Pharmacy | 440 South Brentwood Blvd, Clayton, MO 63105 | 2016-10-05 |
| 1710435565 | James Breihan | Occupational Therapist | 401 Corporate Park Drive, Clayton, MO 63105 | 2016-09-21 |
| 1730566928 | Frank Theus | Counselor | 7710 Carondelet Ave Ste 220, Saint Louis, MO 63105 | 2015-04-27 |
| 1962895896 | John B Martin | Obstetrics & Gynecology | 312 N. Meramec #300, St. Louis, MO 63105 | 2015-03-17 |
| 1861814261 | Jesse Marie Civello | Physical Therapist | 222 S Meramec Avenue, Suite 100, Clayton, MO 63105 | 2014-01-20 |
| Find all providers in zip 63105 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073676755 | Parkcrest Plastic Surgery, Inc. | Surgery | 845 N. New Ballas Court, Suite 300, Saint Louis, MO 63141-7083 | 2006-12-18 |
| 1164536710 | Brock Davis Ridenour | Surgery | 12460 Olive Blvd, Suite 202, Saint Louis, MO 63141-6409 | 2006-08-19 |
| 1962063222 | William Young Zhu | Surgery | 1 Barnes Jew Hosp Plz, Saint Louis, MO 63110-1003 | 2019-06-26 |
| 1619498821 | Lauren Anne Jacobson | Surgery | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2017-06-28 |
| 1649685660 | Elspeth Jane Rose Hill | Surgery | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2014-06-28 |
| 1396092714 | Rajiv Parikh | Surgery | 660 S Euclid Ave, Suite 1150 Northwest Tower, Campus Box 8238, Saint Louis, MO 63110-1010 | 2012-08-06 |
| 1316258106 | Olivier Deigni | Surgery | 1402 S Grand Blvd, Saint Louis, MO 63104-1004 | 2010-06-25 |
| 1649407370 | Scott Jeremy Farber | Surgery | 660 S Euclid Ave # 8109, Department of Surgery, Saint Louis, MO 63110-1010 | 2009-06-20 |
| 1861662272 | Patricia A Mcguire | Surgery | 845 N New Ballas Ct, Suite 300, Saint Louis, MO 63141-7134 | 2008-03-03 |
| 1477723799 | Charles Robert Nathan | Surgery | 845 N New Ballas Ct, Suite 300, Saint Louis, MO 63141-7134 | 2008-03-03 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63105 |
Please comment or provide details below to improve the information on DR. CHARLES DAVID ETTELSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.