Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 00007599 | AL |
N | 207U00000X | Nuclear Medicine Specialist | ME23293 | FL |
NPI | 1053383786 |
---|---|
Provider Name | Thomas Larry Brown SR. |
First Address | Gulf Breeze, FL 32561-4440 |
Second Address | Gulf Breeze, FL 32561-4440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 08/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
069260300 | (05) | FL |
C81376 | (02) |