Provider Demographics
NPI:1700850393
Name:ELI, ALAN M (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:ELI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:20208 STATE HIGHWAY 155 S
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:TX
Practice Address - Zip Code:75762-5600
Practice Address - Country:US
Practice Address - Phone:903-825-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3635207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151333501Medicaid
TX8DH350OtherBCBS
TX750818167049OtherTRICARE
TX752616977011OtherTRICARE CHAMPUS
TX120581OtherCHIPS
TX151333503Medicaid
TXEL08G1190OtherBCBS
TXP01092582OtherRAIL ROAD
TX752616977002OtherTRICARE
TX7649353OtherAETNA
TX151333501Medicaid
TX8804B6Medicare Oscar/Certification
TX750818167049OtherTRICARE
TXP01092582OtherRAIL ROAD
TXTXB160420Medicare Oscar/Certification