Provider Demographics
NPI:1952309833
Name:MARREN, THOMAS F (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:MARREN
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 1:1001 W BROADWAY
Mailing Address - Street 2:PMS -FARMINGTON COMMUNITY HEALTH CENTER
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5638
Mailing Address - Country:US
Mailing Address - Phone:505-327-4796
Mailing Address - Fax:505-325-9113
Practice Address - Street 1:1001 W BROADWAY
Practice Address - Street 2:PMS -FARMINGTON COMMUNITY HEALTH CENTER
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5638
Practice Address - Country:US
Practice Address - Phone:505-327-4796
Practice Address - Fax:505-325-9113
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082611207Q00000X
WI45881207Q00000X
NMMD2011-0630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4524367Medicaid
1034894OtherPREFERREDONE
MN099K5MAOtherBCBS OF MN
WI34409100Medicaid
MITM082611OtherBLUE CROSS BLUE SHIELD MI
MI028Medicare PIN
MI4524367Medicaid
WI015Medicare PIN
1034894OtherPREFERREDONE