Provider Demographics
NPI:1285770651
Name:BRASSFIELD, THOMAS S (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:BRASSFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:BRASSFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3220 N ACADEMY BLVD
Mailing Address - Street 2:5
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5115
Mailing Address - Country:US
Mailing Address - Phone:719-574-3600
Mailing Address - Fax:719-574-1686
Practice Address - Street 1:3220 N ACADEMY BLVD
Practice Address - Street 2:5
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5115
Practice Address - Country:US
Practice Address - Phone:719-574-3600
Practice Address - Fax:719-574-1686
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO22644207QA0000X, 207QA0505X, 207QB0002X, 207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01226448Medicaid
COCO22644OtherCOLORADO STATE LICENSE
COCO22644OtherCOLORADO STATE LICENSE
COCO40749Medicare PIN