Healthcare Provider Details

I. General information

NPI: 1992750079
Provider Name (Legal Business Name): THOMAS E ST AMOUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 KANIS RD STE 330
LITTLE ROCK AR
72205-6339
US

IV. Provider business mailing address

9500 KANIS RD STE 330
LITTLE ROCK AR
72205-6339
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-4900
  • Fax: 501-202-4915
Mailing address:
  • Phone: 501-202-4900
  • Fax: 501-202-4915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberN-7434
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: