Provider Demographics
NPI:1992795389
Name:ISRAEL, ELIZABETH GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GAIL
Last Name:ISRAEL
Suffix:
Gender:F
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 160
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-0160
Mailing Address - Country:US
Mailing Address - Phone:505-368-6020
Mailing Address - Fax:505-368-6431
Practice Address - Street 1:US HWY 491 NORTH
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-6020
Practice Address - Fax:505-368-6431
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001221207P00000X, 207R00000X
CAG84958207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G849580Medicaid
AZ473017Medicaid
NMZ8233Medicaid
CO85773280Medicaid
AZ473017Medicaid
CA00G849580Medicare PIN
8HZ28RMedicare ID - Type Unspecified