Provider Demographics
NPI:1174547723
Name:ELBERS, JEFFREY D (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:ELBERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2025 SLOAN PL
Mailing Address - Street 2:SUITE 35
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2007
Mailing Address - Country:US
Mailing Address - Phone:651-772-1572
Mailing Address - Fax:651-772-1889
Practice Address - Street 1:4786 BANNING AVE
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3264
Practice Address - Country:US
Practice Address - Phone:651-426-6402
Practice Address - Fax:651-429-3402
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN36523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN931220000Medicaid
MN931220000Medicaid