Justin Craig Ellerbroek, MD | |
3741 Pheasant Ln, Waterloo, IA 50701-5215 | |
(319) 234-6000 | |
(319) 234-6001 |
Full Name | Justin Craig Ellerbroek |
---|---|
Gender | Male |
Speciality | Dermatology |
Experience | 18 Years |
Location | 3741 Pheasant Ln, Waterloo, Iowa |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1790981207 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207ND0101X | Dermatology - Mohs-micrographic Surgery | 38816 (Iowa) | Secondary |
207N00000X | Dermatology | 38816 (Iowa) | Primary |
Facility Name | Location | Facility Type |
---|---|---|
Sartori Memorial Hospital, Inc | Cedar falls, IA | Hospital |
Mercyone Waterloo Medical Center | Waterloo, IA | Hospital |
Allen Hospital | Waterloo, IA | Hospital |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Premier Dermatology Ltd | 3173765294 | 3 |
Entity Name | Premier Dermatology Ltd |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1467898007 PECOS PAC ID: 3173765294 Enrollment ID: O20130820000071 |
Mailing Address | Practice Location Address |
---|---|
Justin Craig Ellerbroek, MD Po Box 2400, Waterloo, IA 50704-2400 Ph: (319) 234-6000 | Justin Craig Ellerbroek, MD 3741 Pheasant Ln, Waterloo, IA 50701-5215 Ph: (319) 234-6000 |
Mr. Kent P Ellerbroek, MD Dermatology Medicare: Not Enrolled in Medicare Practice Location: 541 King Dr, Waterloo, IA 50702 Phone: 319-235-6323 Fax: 319-235-0249 | |
Mr. Bryan David Sands, DO Dermatology Medicare: Accepting Medicare Assignments Practice Location: 3812 Pheasant Ln, Waterloo, IA 50701 Phone: 319-236-3444 Fax: 319-236-0257 |