Provider Demographics
NPI:1932193133
Name:ELSON, MARYGRACE (MD)
Entity Type:Individual
Prefix:
First Name:MARYGRACE
Middle Name:
Last Name:ELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-3053
Mailing Address - Fax:319-353-6759
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-3053
Practice Address - Fax:319-353-6759
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33416207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1205195Medicaid
IA17749OtherWELLMARK BCBS
A53677Medicare UPIN
IA1205195Medicaid
IA17749OtherWELLMARK BCBS