Provider Demographics
NPI:1508858036
Name:ROBERTS, THOMAS S (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:ROBERTS
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 1:550 CLUB LANE
Mailing Address - Street 2:SUITE1
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3681
Mailing Address - Country:US
Mailing Address - Phone:501-329-1510
Mailing Address - Fax:501-329-5698
Practice Address - Street 1:525 WESTERN AVE STE 302
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034
Practice Address - Country:US
Practice Address - Phone:501-504-6649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3271207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR51490OtherBCBS
AR114409001Medicaid
AR12592000000OtherQUALCHOICE
AR114652002Medicaid
AR200011968OtherRR MEDICARE
AR51490OtherBCBS
AR51490Medicare PIN