Healthcare Provider Details

I. General information

NPI: 1558672204
Provider Name (Legal Business Name): MARTHA THOMAS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 S POPLAR ST SUITE F
SEARCY AR
72143-6017
US

IV. Provider business mailing address

214 GREEN BAY RD
THIENSVILLE WI
53092-1616
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-5437
  • Fax: 501-268-2057
Mailing address:
  • Phone: 414-247-9005
  • Fax: 414-247-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMC2771
License Number StateAR

VIII. Authorized Official

Name: MRS. MARTHA THOMAS
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 501-268-5437