Healthcare Provider Details

I. General information

NPI: 1912285446
Provider Name (Legal Business Name): EDMOND COLLIN NELSON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 SAPPINGTON BRIDGE RD
SULLIVAN MO
63080-2354
US

IV. Provider business mailing address

660 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8512
US

V. Phone/Fax

Practice location:
  • Phone: 573-468-4186
  • Fax: 573-860-6179
Mailing address:
  • Phone: 314-448-3791
  • Fax: 314-996-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2017027303
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23146
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC0549
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberWV-SE-1846
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.32419
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number65734
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number321099
License Number StateLA
# 8
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number321099
License Number StateLA
# 9
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number79603
License Number StateGA
# 10
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number65734
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: