Provider Demographics
NPI:1710946264
Name:EISENHAUER, GAIL L (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:L
Last Name:EISENHAUER
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 1:4301 W MARKHAM ST # 568
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-526-8200
Mailing Address - Fax:501-526-8299
Practice Address - Street 1:4301 W MARKHAM ST # 568
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-526-8200
Practice Address - Fax:501-526-8299
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH30272084P0800X
ARC-55652084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87437YOtherBLUE SHIELD
TX1280034-01Medicaid
TX260045289OtherRR/MEDICARE
AR5AF74Medicare PIN
TX1280034-01Medicaid
TXC15459Medicare UPIN