Healthcare Provider Details

I. General information

NPI: 1629052931
Provider Name (Legal Business Name): THOMAS GENE ALFANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 EXCHANGE AVE
CONWAY AR
72032-7824
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-2093
  • Fax:
Mailing address:
  • Phone: 480-703-5486
  • Fax: 501-202-6316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberK9478
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number36000
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE-1347
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: