Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | CO22644 | CO |
N | 207QA0505X | Family Doctor - Adult Medicine | CO22644 | CO |
N | 207QG0300X | Family Doctor - Geriatric Medicine | CO22644 | CO |
NPI | 1285770651 |
---|---|
Provider Name | Dr. Thomas S Brassfield |
First Address | Colorado Springs, CO 80917-5115 |
Second Address | Colorado Springs, CO 80917-5115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 19/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01226448 | (05) | CO |
CO22644 | COLORADO STATE LICENSE (01) | CO |
D28304 | (02) | CO |