Individual
PAUL G. ELLERBECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
350 N GRANDVIEW AVE, DUBUQUE, IA 52001-6388
(563) 589-2431
Mailing address
250 MERCY DR, P O BOX 731, DUBUQUE, IA 52004-0731
(563) 589-8616
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
25323
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05045
BCBS PROVIDER NUMBER
IA
Enumeration date
02/06/2006
Last updated
07/31/2013
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