Provider Demographics
NPI:1447204490
Name:MANNING, THOMAS ALLEN III (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALLEN
Last Name:MANNING
Suffix:III
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 1:500 S UNIVERSITY STE 301
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-664-4161
Mailing Address - Fax:501-664-6108
Practice Address - Street 1:500 S UNIVERSITY STE 301
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-664-4161
Practice Address - Fax:501-664-6108
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4098207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP0034518OtherRAILROAD MEDICARE
I28162Medicare UPIN
5N155Medicare PIN