Provider Demographics
NPI:1851359053
Name:BROWN, THOMAS ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROBERT
Last Name:BROWN
Suffix:
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 1:1721 E 19TH AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1251
Mailing Address - Country:US
Mailing Address - Phone:303-861-4505
Mailing Address - Fax:303-861-9036
Practice Address - Street 1:1721 E 19TH AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1251
Practice Address - Country:US
Practice Address - Phone:303-861-4505
Practice Address - Fax:303-861-9036
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30068208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COBR40275OtherBC/BS INDIVIDUAL
COCO653774OtherBC/BS GROUP
COTHF2808OtherBC/BS GROUP
CO01300680Medicaid
COBRF2818OtherBC/BS INDIVIDUAL
COBR40275OtherBC/BS INDIVIDUAL
COCO653774OtherBC/BS GROUP
84-1204261OtherEIN - ADVANCED SURGICAL
805458Medicare PIN
84-1294507OtherEIN CBSI