Healthcare Provider Details

I. General information

NPI: 1215902358
Provider Name (Legal Business Name): THOMAS CHARLES BONIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 WHITETAIL LN
GREENWOOD AR
72936-6821
US

IV. Provider business mailing address

459 WHITETAIL LN
GREENWOOD AR
72936-6821
US

V. Phone/Fax

Practice location:
  • Phone: 479-252-2070
  • Fax:
Mailing address:
  • Phone: 479-252-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21066
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-0161
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: