Provider Demographics
NPI:1902975618
Name:BROWN, TOM TARTT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:TARTT
Last Name:BROWN
Suffix:JR
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 1:2660 10TH AVE S
Mailing Address - Street 2:STE. 225
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1605
Mailing Address - Country:US
Mailing Address - Phone:205-933-5808
Mailing Address - Fax:205-930-2119
Practice Address - Street 1:2660 10TH AVE S
Practice Address - Street 2:STE. 225
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1605
Practice Address - Country:US
Practice Address - Phone:205-933-5808
Practice Address - Fax:205-930-2119
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAB9673129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000010487Medicaid
AL051010487OtherBCBS OF ALABAMA
AL110003757OtherMEDICARE RAILROAD
AL110003757OtherMEDICARE RAILROAD
ALC73096Medicare UPIN