Provider Demographics
NPI:1306816087
Name:CAIN, THOMAS DARRELL (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DARRELL
Last Name:CAIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10001 LILE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6217
Mailing Address - Country:US
Mailing Address - Phone:501-227-8000
Mailing Address - Fax:501-320-1682
Practice Address - Street 1:10001 LILE DRIVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6217
Practice Address - Country:US
Practice Address - Phone:501-227-8000
Practice Address - Fax:501-320-1682
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC4920207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103645001Medicaid
AR50846OtherMEDICARE
AR110053662OtherRAILROAD MEDICARE
AR686809OtherMEDICARE ID# FOR CHI ST. VINCENT LITTLE ROCK DIAGNOSTIC CLINIC