Provider Demographics
NPI:1376583328
Name:MULLIGAN, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:MULLIGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:
Other - Last Name:MULLIGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:303 E MATTHEWS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3120
Mailing Address - Country:US
Mailing Address - Phone:870-207-7555
Mailing Address - Fax:870-336-5083
Practice Address - Street 1:303 E MATTHEWS AVE STE 202
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3120
Practice Address - Country:US
Practice Address - Phone:870-207-7555
Practice Address - Fax:870-336-5083
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93118207RG0300X
ARE5074207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272704800Medicaid
I35809Medicare UPIN
FL16135Medicare ID - Type Unspecified