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Individual

MR. KENT P ELLERBROEK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
541 KING DR, WATERLOO, IA 50702-5959
(319) 235-6323
(319) 235-0249
Mailing address
541 KING DR, WATERLOO, IA 50702-5959
(319) 235-6323
(319) 235-0249

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
20213
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0169805
IA
Enumeration date
12/02/2005
Last updated
10/14/2008
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