MEDICARE: DR. MATTHEW TAYLOR NELSON D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	2010017744	MO

General Provider Information

NPI Number	:	1922310929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW TAYLOR NELSON D.O.

Provider Business Mailing Address
First Line	:	6018 WAGON MOUNT CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-4043
Country	:	US
Telephone Number	:	734-771-1591
Fax Number	:

Provider Business Practice Location Address
First Line	:	6018 WAGON MOUNT CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-4043
Country	:	US
Telephone Number	:	734-771-1591
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2010
Last Update Date	:	07/07/2010

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