Eliason, Bert Clair
Eliason, Bert Clair is an individual health care provider with primary practice located at 516 E. Nizhoni Blvd. , Gallup NM 87301-1337. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Eliason, Bert Clair can be contacted via phone (505) 722-1000.Contact Information
Primary practice address
516 E. Nizhoni Blvd.
Gallup NM 87301-1337
Phone: (505) 722-1000
Fax: (505) 726-8740
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 036099778 | Illinois |
Profile Details
| NPI number | 1174513113 |
|---|---|
| LBN Legal business name | Eliason, Bert Clair |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 21st, 2005 |
| Last updated | Mar 7th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174513113 | NPPES |
| Illinois | Other | 036099778 | IL STATE LICENSE |
| Illinois | Other | 336060100 | IL STATE LICENSE |
| Illinois | MEDICAID | 036099778 | IL STATE LICENSE |
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