Provider Demographics
NPI:1750385563
Name:MEZIERE, TOM L (MD)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:L
Last Name:MEZIERE
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 1:409 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3108
Mailing Address - Country:US
Mailing Address - Phone:501-664-6980
Mailing Address - Fax:501-664-4738
Practice Address - Street 1:409 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3108
Practice Address - Country:US
Practice Address - Phone:501-664-6980
Practice Address - Fax:501-664-4738
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-7626207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR115634001Medicaid
AR327509Medicare PIN
E02948Medicare UPIN