Provider Demographics
NPI:1326111527
Name:ELIASON, HOWARD J (DO)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:J
Last Name:ELIASON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 GREENHILL CT
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5454
Mailing Address - Country:US
Mailing Address - Phone:817-788-4665
Mailing Address - Fax:
Practice Address - Street 1:1608 GREENHILL CT
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5454
Practice Address - Country:US
Practice Address - Phone:817-788-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1234207Q00000X
ND5207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine