| Gary Earl Ellwein, MD | |
|
3100 Channing Way, Idaho Falls, ID 83404-7533 | |
| (208) 529-6050 | |
| (208) 529-7085 |
| Full Name | Gary Earl Ellwein |
|---|---|
| Gender | Male |
| Speciality | Pathology - Anatomic Pathology & Clinical Pathology |
| Location | 3100 Channing Way, Idaho Falls, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063480804 | NPI | - | NPPES |
| 003682000 | Medicaid | ID | |
| 000010003940 | Other | ID | REGENCE BLUE SHIELD OF ID |
| 32625 | Other | ID | BLUE CROSS OF IDAHO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207ZP0102X | Pathology - Anatomic Pathology & Clinical Pathology | M3265 (Idaho) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Gary Earl Ellwein, MD 1820 E 17th St, Ste 230, Idaho Falls, ID 83404-6521 Ph: (208) 529-9779 | Gary Earl Ellwein, MD 3100 Channing Way, Idaho Falls, ID 83404-7533 Ph: (208) 529-6050 |
Matt Tannenbaum, MD Pathology Medicare: Accepting Medicare Assignments Practice Location: 3100 Channing Way, Idaho Falls, ID 83404 Phone: 208-529-6050 Fax: 208-529-7085 | |
Clark R Daines, MD Pathology Medicare: Accepting Medicare Assignments Practice Location: 3100 Channing Way, Idaho Falls, ID 83404 Phone: 208-529-6050 Fax: 208-529-7085 | |
Floyd Joseph Fantelli, MD Pathology Medicare: Not Enrolled in Medicare Practice Location: 3100 Channing Way, Idaho Falls, ID 83404 Phone: 208-529-6050 Fax: 208-529-7085 | |
Dr. Gabriele Emma Teermann, MD Pathology Medicare: Accepting Medicare Assignments Practice Location: 3100 Channing Way, Idaho Falls, ID 83404 Phone: 208-529-6048 Fax: 208-529-7085 |