Kent P Ellerbroek MD PC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

202213 Issued in IA

Legal business name

KENT P ELLERBROEK MD PC

Practice address

541 King Dr
Waterloo, IA 50702-5959

Phone

(319) 235-6323

Fax

(319) 235-0249

NPI assigned

Jul 7, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kent P Ellerbroek, M.D.

Title

Medical Doctor

Phone

(319) 235-6323

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert William Fuelling, D.C.

  • Chiropractor
  • Waterloo, IA
  • NPI 1083729057
  NPD (past)
• Brady Hakeman, D.C.

  • Chiropractor
  • Waterloo, IA
  • NPI 1013284488
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223942400000",
    "number": "1346403755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 KING DR",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025959",
            "telephone_number": "319-235-6323",
            "fax_number": "319-235-0249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 KING DR",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025959",
            "telephone_number": "319-235-6323",
            "fax_number": "319-235-0249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENT P ELLERBROEK MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-07",
        "last_updated": "2008-10-14",
        "status": "A",
        "authorized_official_last_name": "ELLERBROEK",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "319-235-6323",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IA",
            "license": "202213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Jacob Zion Kelly, FNP-BC
• Mary P Kelly, D.C.
• Helen Maree Kemp, LMSW
• Jeffrey Alan Kemp, MS, PT
• Jared Kennedy, DC
• Jessica Elizabeth Kepple, CNM
• Kerry Sullivan Counseling PLLC
• Kettman Pranger Family Medicine, PLLC
• Kettman Psychiatric Practice PC
• Matthew J Kettman, MD

• MOHS-Micrographic Surgery Physician in Waterloo, IA
• Providers in Waterloo, IA by specialty
• MOHS-Micrographic Surgery Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.