Provider Demographics
NPI:1588748990
Name:EBERLE, ANDREA J (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:EBERLE
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 15968
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72231-5968
Mailing Address - Country:US
Mailing Address - Phone:501-221-1843
Mailing Address - Fax:501-221-2376
Practice Address - Street 1:1109 BURMAN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4386
Practice Address - Country:US
Practice Address - Phone:501-982-7575
Practice Address - Fax:501-982-7510
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-2034207R00000X, 207RA0000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135989001Medicaid
AR5L052OtherAR BCBS
AR5L052Medicare ID - Type Unspecified
AR5L052OtherAR BCBS