NPI 1063480804

Gary Earl Ellwein, MD

Practitioner Anatomic Pathology & Clinical Pathology Physician Idaho Falls, ID

Practice location

Address: 3100 Channing Way, Idaho Falls, ID 83404-7533
Phone: (208) 529-6050
Fax: (208) 529-7085
Mailing address: 1820 E 17th St STE 230, Idaho Falls, ID 83404-6521

Registered specialties

Anatomic Pathology & Clinical Pathology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207ZP0102X Licence M3265 (ID)

Other Pathology providers in Idaho →

Registry record

NPI: 1063480804
Entity type: Individual
Sex (as registered): Male
NPI issued: 9 Mar 2006
Record last updated: 27 Dec 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.