Basic Information
| Provider Information | |||||||||
| NPI: | 1265539720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GATH | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | CAROL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4301 W MARKHAM ST # 641 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722057101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016868000 | ||||||||
| FaxNumber: | 5016868765 | ||||||||
| Practice Location | |||||||||
| Address1: | 4301 W MARKHAM ST # 641 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722057101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016868000 | ||||||||
| FaxNumber: | 5016868765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2006 | ||||||||
| LastUpdateDate: | 01/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 159435 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | E-7304 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01508465 | 05 | NY | MEDICAID | 10006299 | 01 | NY | CDPHP | OTHER | 11948 | 01 | NY | MVP | OTHER | 2697144 | 01 | NY | GHI | OTHER | 000401503014 | 01 | NY | BSNENY | OTHER | 820585734 | 01 | NY | TRICARE | OTHER | 820585734 | 01 | NY | EMPIRE | OTHER | 72441 | 01 | NY | GHIHMO | OTHER | 110247037 | 01 | NY | RRMCR | OTHER |