Provider Demographics
NPI:1669454930
Name:BROWN, THOMAS M JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 LAUREL ST STE A250
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3029
Mailing Address - Country:US
Mailing Address - Phone:515-235-5000
Mailing Address - Fax:515-288-6713
Practice Address - Street 1:411 LAUREL ST
Practice Address - Street 2:SUITE A250
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3017
Practice Address - Country:US
Practice Address - Phone:515-235-5000
Practice Address - Fax:515-288-6713
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20091207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0127720Medicaid
IA12772Medicare ID - Type Unspecified
IA0127720Medicaid