Healthcare Provider Details

I. General information

NPI: 1720083082
Provider Name (Legal Business Name): THOMAS JAMES SMALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W JEFFERSON ST STE H
FRANKLIN IN
46131-2184
US

IV. Provider business mailing address

1101 W JEFFERSON ST STE H
FRANKLIN IN
46131-2184
US

V. Phone/Fax

Practice location:
  • Phone: 317-736-9655
  • Fax: 317-738-0922
Mailing address:
  • Phone: 317-736-9655
  • Fax: 317-738-0922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0102451A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01025451A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25451
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: