DR. CHARLES DAVID ETTELSON M.D.
NPI 1255332904
Surgery - Plastic and Reconstructive Surgery in Saint Louis, MO

Q: What is Charles Ettelson's NPI number?

The NPI number for Charles Ettelson is 1255332904. It was assigned to this individual provider in the NPPES registry on August 3, 2005.

Q: What is Charles Ettelson's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

Q: When was this NPI record last updated?

The NPPES record for Charles Ettelson was last updated on July 2, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 03, 2005

730 AUDUBON DR, SAINT LOUIS, MO 63105(314) 324-7605 Get Directions Write a Review

NPPES record last updated: July 2, 2013. Verified against the NPPES registry weekly; last sync: August 30, 2026.

On this page

About Dr. Charles David Ettelson M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. CHARLES DAVID ETTELSON M.D. (NPI 1255332904) is an individual plastic and reconstructive surgery provider in Saint Louis, Missouri, licensed in Missouri (R9446) and active in the NPI registry since August 2005.

NPPES Registry Identity

NPI1255332904

Entity TypeIndividualMale

Primary Taxonomy2086S0122X

Provider Legal NameDR. CHARLES DAVID ETTELSONCredential: M.D.

Location Address730 AUDUBON DRSaint Louis, MO 63105-2906

Mailing Address730 Audubon DrSaint Louis, MO 63105-2906 · (314) 324-7605

Phone(314) 324-7605

Sole ProprietorYes

Enumeration DateAugust 3, 2005

Last NPPES UpdateJuly 2, 2013

✔ NPI 1255332904 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code2086S0122X

License✔ Licensed in MO · R9446

Definition

A surgeon who specializes in plastic and reconstructive surgery.

730 AUDUBON DR, Saint Louis, MO 63105

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Other Identifiers 2

Medicare ID-Type Unspecified000000033MO

Medicare UPINAEO957MO

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Charles Ettelson's NPI number?

The NPI number for Charles Ettelson is 1255332904. It was assigned to this individual provider in the NPPES registry on August 3, 2005.

Where is Charles Ettelson located?

Charles Ettelson practices at 730 Audubon Dr, Saint Louis, MO 63105. The listed phone number is (314) 324-7605.

What is Charles Ettelson's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

When was this NPI record last updated?

The NPPES record for Charles Ettelson was last updated on July 2, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.