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
Fax: (505) 726-8740
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
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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