Provider Demographics
NPI:1174672356
Name:THOMAS, JAMES EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:THOMAS
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 1:1000 HWY 35 N.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-2351
Mailing Address - Country:US
Mailing Address - Phone:501-315-1117
Mailing Address - Fax:501-315-2408
Practice Address - Street 1:1000 HWY 35 N.
Practice Address - Street 2:SUITE 5
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-2351
Practice Address - Country:US
Practice Address - Phone:501-315-1117
Practice Address - Fax:501-315-2408
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE20102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5L029G428OtherPTAN
18328000000OtherQUALCHOICE
AR7115035OtherAETNA
AR124224001Medicaid
130021238OtherRAILROAD MEDICARE
18328000000OtherQUALCHOICE
5L029G428OtherPTAN