Provider Demographics
NPI:1851309843
Name:ELSON, JOEL D (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:D
Last Name:ELSON
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 4460
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104
Mailing Address - Country:US
Mailing Address - Phone:866-491-5807
Mailing Address - Fax:913-491-0411
Practice Address - Street 1:16901 LAKESIDE HILLS CT
Practice Address - Street 2:ALEGENT LAKESIDE - DEPT OF RADIOLOGY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2318
Practice Address - Country:US
Practice Address - Phone:402-717-8146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE147062085R0202X
IA216902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE14706OtherLICENSE NUMBER
1602793OtherUHC SHARE ALLIANCE
1602795OtherUHC SHARE ALLIANCE
1602797OtherUHC SHARE ALLIANCE
IA21690OtherLICENSE NUMBER
3957OtherMIDLANDS
1602794OtherUHC SHARE ALLIANCE
12161953OtherDOB
1602773OtherUHC SHARE ALLIANCE
NE06265OtherBCBS
1602796OtherUHC SHARE ALLIANCE
1602796OtherUHC SHARE ALLIANCE
IA21690OtherLICENSE NUMBER
1602796OtherUHC SHARE ALLIANCE
NE14706OtherLICENSE NUMBER
1602773OtherUHC SHARE ALLIANCE
1602793OtherUHC SHARE ALLIANCE
IAI15169Medicare PIN