Healthcare Provider Details

I. General information

NPI: 1447203120
Provider Name (Legal Business Name): GAIL A MCCRACKEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 W 10TH ST SUITE 610 FREEWAY MEDICAL CENTER
LITTLE ROCK AR
72204-1755
US

IV. Provider business mailing address

5800 W 10TH ST SUITE 610 FREEWAY MEDICAL CENTER
LITTLE ROCK AR
72204-1755
US

V. Phone/Fax

Practice location:
  • Phone: 501-661-9393
  • Fax: 501-663-4795
Mailing address:
  • Phone: 501-661-9393
  • Fax: 501-663-4795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC6075
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: