Provider Demographics
NPI:1669467361
Name:TOMMEY, R C (MD)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:C
Last Name:TOMMEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:704 W GROVE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4416
Mailing Address - Country:US
Mailing Address - Phone:870-875-5580
Mailing Address - Fax:870-875-5584
Practice Address - Street 1:704 W GROVE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4416
Practice Address - Country:US
Practice Address - Phone:870-875-5580
Practice Address - Fax:870-875-5584
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC5246208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106126001Medicaid
D83894Medicare UPIN
AR55347Medicare PIN