Provider Demographics
NPI:1992760706
Name:HINTON, THOMAS WADE (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WADE
Last Name:HINTON
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 1523
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1523
Mailing Address - Country:US
Mailing Address - Phone:479-571-6038
Mailing Address - Fax:479-582-0222
Practice Address - Street 1:3344 N FUTRALL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-443-5312
Practice Address - Fax:479-582-7389
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM01112085R0202X
ARE-44532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174275101Medicaid
ARP00322549OtherRR MCR
OK200086100AMedicaid
AR160615001Medicaid
AR5N477OtherAR BCBS
TX8D5448Medicare ID - Type Unspecified
TX174275101Medicaid
AR5N477C912Medicare PIN
AR5N477Medicare ID - Type Unspecified