Provider Demographics
NPI:1629052931
Name:ALFANO, THOMAS GENE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GENE
Last Name:ALFANO
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 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:480-703-5486
Mailing Address - Fax:501-202-6316
Practice Address - Street 1:1555 EXCHANGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-7824
Practice Address - Country:US
Practice Address - Phone:501-202-2093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9478207L00000X
AZ36000207L00000X
ARE-1347207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA6116188OtherDEA
AZZ172542Medicare PIN
AZZ125418Medicare PIN
AZP00873422Medicare PIN
BA6116188OtherDEA