Provider Demographics
NPI:1780640243
Name:BRAND, THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:BRAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4520
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0075
Mailing Address - Country:US
Mailing Address - Phone:514-690-7314
Mailing Address - Fax:541-469-0731
Practice Address - Street 1:17265 MT DR # 4520
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9296
Practice Address - Country:US
Practice Address - Phone:514-690-7314
Practice Address - Fax:541-469-0731
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2015-03-14
Deactivation Date:2007-08-20
Deactivation Code:
Reactivation Date:2014-02-10
Provider Licenses
StateLicense IDTaxonomies
ORDO20224207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E 08851Medicare UPIN
MI114830389Medicaid