Basic Information
| Provider Information | |||||||||
| NPI: | 1003002510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEGRAFF | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 CMS WILLIAMS DRIVE | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK AFB | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019876951 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 101 CMS WILLIAMS DRIVE | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK AFB | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720993427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019876951 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2007 | ||||||||
| LastUpdateDate: | 04/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083A0100X | A141807 | NM | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine | 208D00000X | E-8909 | AR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.