Bert Clair Eliason, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036099778 Issued in IL

Practice address

516 E. Nizhoni Blvd.
Gallup, NM 87301-1337

Phone

(505) 722-1000

Fax

(505) 726-8740

NPI assigned

Oct 21, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1174513113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4185 LEIGH LANE",
            "city": "ALTA",
            "state": "WY",
            "postal_code": "83414",
            "telephone_number": "801-471-8894",
            "fax_number": "909-382-4524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 E. NIZHONI BLVD.",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873011337",
            "telephone_number": "505-722-1000",
            "fax_number": "505-726-8740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELIASON",
        "first_name": "BERT",
        "middle_name": "CLAIR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-21",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036099778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL STATE LICENSE",
            "identifier": "036099778",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL STATE CTL SUB LICENSE",
            "identifier": "336060100",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036099778",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sharon Yazzie Edison
• Fredric Edwards, RN
• Beatrice Belangeli Efamba
• Nathaniel Egbert, RN
• Braiden Eilers, MD
• Joseph Lee Eliason, CNP, FNP-C, CWS
• Mark Andrew Elliott, RN
• Magret C Ellis
• Iona Marie Ellsworth-Jensen, RNBS
• Robin Ellsworth

• Family Medicine Physician in Gallup, NM
• Providers in Gallup, NM by specialty
• Family Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.