Provider Demographics
NPI:1164448858
Name:BRASWELL, THOMAS ROSS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROSS
Last Name:BRASWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SAINT VINCENT CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5423
Mailing Address - Country:US
Mailing Address - Phone:501-552-7999
Mailing Address - Fax:501-552-7998
Practice Address - Street 1:15033 HIGHWAY 165
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:AR
Practice Address - Zip Code:72142-9555
Practice Address - Country:US
Practice Address - Phone:501-552-7999
Practice Address - Fax:501-552-7998
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102981001Medicaid
AR12321000000OtherQC
AR428494OtherHEALTHLINK
AR5397026OtherAETNA
AR428494OtherHEALTHLINK
AR50615Medicare ID - Type Unspecified
AR12321000000OtherQC
AR50615Medicare PIN
AR930022340Medicare PIN