Basic Information
| Provider Information | |||||||||
| NPI: | 1174559447 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELBRIDGE | ||||||||
| FirstName: | ARNOLD | ||||||||
| MiddleName: | EUGENE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4150 KIMBALL AVE | ||||||||
| Address2: | PO BOX 2758 | ||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507019086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192336448 | ||||||||
| FaxNumber: | 3192334240 | ||||||||
| Practice Location | |||||||||
| Address1: | 164 WEST DALE ST | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507031925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192336448 | ||||||||
| FaxNumber: | 3192334240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 11/19/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 20001 | IA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 42141730702 | 01 | IA | JOHN DEERE HEALTH | OTHER | 1137182 | 05 | IA | MEDICAID | 19287 | 01 | IA | WELLMARK HEALTHCARE | OTHER |