Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Charles David Ettelson, MD

Individual provider Plastic and Reconstructive Surgery Physician · NPI 1255332904

Dr. Charles David Ettelson, MD is a Plastic and Reconstructive Surgery Physician in Saint Louis, Missouri. Practices as a sole proprietor. Licensed in Missouri.

Licensed in
MO
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

730 Audubon Dr
Saint Louis, MO 63105-2906
Phone: (314) 324-7605
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Plastic and Reconstructive Surgery Physician (primary) Taxonomy 2086S0122X · Licence R9446 (MO)

Record details

NPI number1255332904
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedAugust 3, 2005
Last updated in NPPESJuly 2, 2013

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