Provider Demographics
NPI:1790781342
Name:EELLS, ROBERT (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:EELLS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E ARMY POST RD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-5970
Mailing Address - Country:US
Mailing Address - Phone:515-244-0633
Mailing Address - Fax:515-244-2412
Practice Address - Street 1:1111 E ARMY POST RD
Practice Address - Street 2:SUITE 470
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-5970
Practice Address - Country:US
Practice Address - Phone:515-244-0633
Practice Address - Fax:515-244-2412
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00571213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA028602OtherPRINCIPAL
IA45971OtherWELLMARK BCBS
IA6286AOtherCOVENTRY
IA1112342Medicaid
IA46254Medicare PIN
IA480026377Medicare PIN
IA028602OtherPRINCIPAL
IA1249930001Medicare NSC