Provider Demographics
NPI:1437192911
Name:BROWN, THOMAS L JR (M D)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3777 MACKEY COVE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-8152
Mailing Address - Country:US
Mailing Address - Phone:850-418-4107
Mailing Address - Fax:
Practice Address - Street 1:8383 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6039
Practice Address - Country:US
Practice Address - Phone:850-494-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90656207P00000X
TN35484207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16402OtherBCBS PROVIDER NUMBER
FL273467200Medicaid
KY64053986Medicaid
FL16402OtherBCBS PROVIDER NUMBER
KY64053986Medicaid
TN103I932040Medicare PIN