=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386747277
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS M BROWN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2006
-----------------------------------------------------
Last Update Date | 12/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7400 MERTON MINTER ST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-4404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-617-5300
-----------------------------------------------------
Fax | 210-949-3918
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6110 FIRST COLONY
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78240-5342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-632-3269
-----------------------------------------------------
Fax | 210-949-3918
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | L0052
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | L0052
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------