Provider Demographics
NPI:1972557783
Name:BROWN, THOMAS D (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
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 1:500 S BEACH ST APT F1
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5024
Mailing Address - Country:US
Mailing Address - Phone:321-439-1477
Mailing Address - Fax:
Practice Address - Street 1:7524 CYPRESS GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-3200
Practice Address - Country:US
Practice Address - Phone:863-535-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME621442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17851ZOtherMEDICARE
FL375499500Medicaid
FL17851Medicare ID - Type Unspecified
FL375499500Medicaid