Healthcare Provider Details

I. General information

NPI: 1649223033
Provider Name (Legal Business Name): THOMAS JOHN TINNESZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 DETROIT STREET
DANVILLE AR
72833
US

IV. Provider business mailing address

PO BOX 639
DANVILLE AR
72833-0639
US

V. Phone/Fax

Practice location:
  • Phone: 479-495-2241
  • Fax: 479-495-6299
Mailing address:
  • Phone: 479-495-2241
  • Fax: 479-495-6299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR-3688
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: