Provider Demographics
NPI:1881633816
Name:BROWN, TIMOTHY ROLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ROLAND
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:PO BOX 1292
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81215-1292
Mailing Address - Country:US
Mailing Address - Phone:719-275-4061
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28896208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06575749Medicaid
COC13481Medicare ID - Type Unspecified
CO06575749Medicaid