Provider Demographics
NPI:1295186328
Name:GINGERICH-BOBERG, MD, D PIERRE (MD)
Entity Type:Individual
Prefix:
First Name:D
Middle Name:PIERRE
Last Name:GINGERICH-BOBERG, MD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2055 KIMBALL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5047
Mailing Address - Country:US
Mailing Address - Phone:319-272-2112
Mailing Address - Fax:319-272-2107
Practice Address - Street 1:2055 KIMBALL AVE STE 101
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5047
Practice Address - Country:US
Practice Address - Phone:319-272-2112
Practice Address - Fax:319-272-2107
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR107029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine