Provider Demographics
NPI:1992750079
Name:ST AMOUR, THOMAS E (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:ST AMOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9500 KANIS RD STE 330
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6339
Mailing Address - Country:US
Mailing Address - Phone:501-202-4900
Mailing Address - Fax:501-202-4915
Practice Address - Street 1:9500 KANIS RD STE 330
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6339
Practice Address - Country:US
Practice Address - Phone:501-202-4900
Practice Address - Fax:501-202-4915
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARN-74342085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR516596945OtherMEDICARE ID
AR114497001Medicaid
ARA13774Medicare UPIN