MEDICARE: DR. THOMAS S BRASSFIELD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0000X	Adolescent Medicine (Family Medicine) Physician	CO22644	CO
2	207QA0505X	Adult Medicine Physician	CO22644	CO
3	207QB0002X	Obesity Medicine (Family Medicine) Physician	CO22644	CO
4	207QG0300X	Geriatric Medicine (Family Medicine) Physician	CO22644	CO
5	207Q00000X	Family Medicine Physician	CO22644	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	CO22644	OTHER	CO	COLORADO STATE LICENSE

General Provider Information

NPI Number	:	1285770651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS S BRASSFIELD M.D.

Provider Business Mailing Address
First Line	:	3220 N ACADEMY BLVD
Second Line	:	5
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5115
Country	:	US
Telephone Number	:	719-574-3600
Fax Number	:	719-574-1686

Provider Business Practice Location Address
First Line	:	3220 N ACADEMY BLVD
Second Line	:	5
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5115
Country	:	US
Telephone Number	:	719-574-3600
Fax Number	:	719-574-1686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	05/19/2010

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