Provider Demographics
NPI:1770902397
Name:STRUBE, ELLIOTT LEVI (DO)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:LEVI
Last Name:STRUBE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:LEVI
Other - Middle Name:
Other - Last Name:STRUBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-1239
Mailing Address - Country:US
Mailing Address - Phone:573-629-3441
Mailing Address - Fax:573-629-3416
Practice Address - Street 1:6500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6890
Practice Address - Country:US
Practice Address - Phone:573-629-3441
Practice Address - Fax:573-629-3416
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1377208000000X
390200000X
MO2020033146208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program