Healthcare Provider Details

I. General information

NPI: 1407835085
Provider Name (Legal Business Name): ROBERT C NIELSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 COLUMBIA AVE
OSAGE BEACH MO
65065-8689
US

IV. Provider business mailing address

3870 COLUMBIA AVE
OSAGE BEACH MO
65065-8689
US

V. Phone/Fax

Practice location:
  • Phone: 573-302-7490
  • Fax: 573-302-7895
Mailing address:
  • Phone: 573-302-7490
  • Fax: 573-302-7895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO103086
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number103086
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: