NPI 1174513113 · live from the CMS NPI Registry
Bert Clair Eliason, M.D.
Family Medicine in Gallup, NM. National Provider Identifier 1174513113, active.
NPI record
| NPI | 1174513113 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 516 E. Nizhoni Blvd., Gallup, NM 87301 |
| Practice phone | 505-722-1000 |
| Mailing address | 4185 Leigh Lane, Alta, WY 83414 |
| Enumerated | October 21, 2005 |
| Last updated | March 7, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine primary | 207Q00000X | 036099778 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.