Provider Demographics
NPI:1285694497
Name:LUEBBERT, ERIC E (DO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:E
Last Name:LUEBBERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 UNIVERSITY AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5945
Mailing Address - Country:US
Mailing Address - Phone:515-226-7426
Mailing Address - Fax:515-226-8506
Practice Address - Street 1:701 E 2ND ST
Practice Address - Street 2:
Practice Address - City:IDA GROVE
Practice Address - State:IA
Practice Address - Zip Code:51445-1699
Practice Address - Country:US
Practice Address - Phone:712-364-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1285694497Medicaid
26250OtherBCBS OF IOWA
IA0229336Medicaid
SD7200540Medicaid
26240OtherBCBS OF IOWA
E86747Medicare UPIN