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Individual

JAMES ROBERT EBBEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1970 S RIDGE RD, GREEN BAY, WI 54304-4125
(920) 430-4888
(920) 430-4889
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7226
(920) 445-7238

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29793
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
29793
LICENSE
WI
01
354601
AMERICAN BOARD OF FAMILY MEDICINE-SPORTS MEDICINE
Enumeration date
12/08/2005
Last updated
05/18/2021
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