Provider Demographics
NPI:1255498556
Name:CONVERSE, THOMAS ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALLEN
Last Name:CONVERSE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1405 LILAC DR N
Mailing Address - Street 2:STE 150
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4535
Mailing Address - Country:US
Mailing Address - Phone:763-544-8194
Mailing Address - Fax:763-544-4413
Practice Address - Street 1:1405 LILAC DR N
Practice Address - Street 2:STE 150
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4535
Practice Address - Country:US
Practice Address - Phone:763-544-8194
Practice Address - Fax:763-544-4413
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN232392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry