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General NPI Number Information
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NPI Number | 1003002510
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Entity Type | Individual
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Provider Name | THOMAS RICHARD DEGRAFF III D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 101 CMS WILLIAMS DRIVE
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City | LITTLE ROCK AFB
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State | AR
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Zip | 72099-3427
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Country | US
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Telephone | 501-987-6951
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Fax |
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Provider Business Mailing Address
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Address Line | 101 CMS WILLIAMS DRIVE
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City | LITTLE ROCK AFB
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State | AR
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Zip | 72099-0001
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Country | US
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Telephone | 501-987-6951
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | A141807
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | E-8909
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License Number State | AR
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