Provider Demographics
NPI:1194010165
Name:BROWN, ROBERT THOMAS
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:THOMAS
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11055 EMERALD CT
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-9344
Mailing Address - Country:US
Mailing Address - Phone:573-308-9999
Mailing Address - Fax:
Practice Address - Street 1:11055 EMERALD CT
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-9344
Practice Address - Country:US
Practice Address - Phone:573-308-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3SM647347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle