Provider Demographics
NPI:1366658346
Name:IRBY, ELIZABETH WEBB (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WEBB
Last Name:IRBY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:WEBB
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:11001 EXECUTIVE CENTER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211
Mailing Address - Country:US
Mailing Address - Phone:501-812-7587
Mailing Address - Fax:
Practice Address - Street 1:11719 HINSON ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212
Practice Address - Country:US
Practice Address - Phone:501-224-2875
Practice Address - Fax:201-221-9251
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR185541003Medicaid
4P798Medicare PIN