Provider Demographics
NPI:1346449154
Name:TIMOTHY R BROWN MD
Entity Type:Organization
Organization Name:TIMOTHY R BROWN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-275-4061
Mailing Address - Street 1:1335 PHAY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2349
Mailing Address - Country:US
Mailing Address - Phone:171-927-5406
Mailing Address - Fax:719-275-4058
Practice Address - Street 1:1335 PHAY AVE STE D
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2349
Practice Address - Country:US
Practice Address - Phone:719-275-4061
Practice Address - Fax:719-275-4058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC028896174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06575749Medicaid