Provider Demographics
NPI:1265539720
Name:GATH, ELIZABETH CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CAROL
Last Name:GATH
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 # 641
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:501-686-8000
Mailing Address - Fax:501-686-8765
Practice Address - Street 1:4301 W MARKHAM ST # 641
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:501-686-8000
Practice Address - Fax:501-686-8765
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159435207R00000X
ARE-7304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01508465Medicaid
NY10006299OtherCDPHP
NY11948OtherMVP
NY2697144OtherGHI
NY000401503014OtherBSNENY
NY820585734OtherTRICARE
NY820585734OtherEMPIRE
NY72441OtherGHIHMO
NY110247037OtherRRMCR
NY000401503014OtherBSNENY
NY110247037OtherRRMCR
AR5AN19Medicare PIN