Provider Demographics
NPI:1649223033
Name:TINNESZ, THOMAS JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:TINNESZ
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:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72833-0639
Mailing Address - Country:US
Mailing Address - Phone:479-495-2241
Mailing Address - Fax:479-495-6299
Practice Address - Street 1:719 DETROIT STREET
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:AR
Practice Address - Zip Code:72833
Practice Address - Country:US
Practice Address - Phone:479-495-2241
Practice Address - Fax:479-495-6299
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-3688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR710800715OtherGEHA
AR112619001Medicaid
AR50830OtherBLUE CROSS BLUE SHIELD
AR710800715OtherCIGNA
AR020035810OtherRAILROAD MEDICARE
OK100018580AMedicaid
AR710800715OtherUNITED HEALTHCARE
AR710800715OtherNOVASYS
AR710800715OtherAETNA
AR710800715OtherCORESOURCE
AR710800715OtherDELTA HEALTH SYSTEM
ARB90053Medicare UPIN
AR710800715OtherCORESOURCE