Provider Demographics
NPI:1750349098
Name:WIEDOWER EBLE, AMY CATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:CATHERINE
Last Name:WIEDOWER EBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9601 LILE DR
Mailing Address - Street 2:500
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-227-5885
Mailing Address - Fax:501-227-5005
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:500
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-227-5885
Practice Address - Fax:501-227-5005
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE2453207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M164Medicare ID - Type Unspecified
AR60438Medicare UPIN