Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207W00000X | Ophthalmology | | 37088 | ARIZONA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 784039 | OTHER | | MVP HEALTH CARE |
| 2 | I19737 | MEDICARE UPIN | ARIZONA | |
| 3 | 042472266 | OTHER | ARIZONA | TRICARE CAMPUS |
| 4 | 69793 | OTHER | ARIZONA | HEALTHYSTART |
| 5 | 9317749 | OTHER | ARIZONA | CIGNA HEALTH PLAN |
| 6 | 2098466 | MEDICAID | ARIZONA | |
| 7 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 8 | 0801554 | OTHER | | EVERCARE |
| 9 | AA15528 | OTHER | ARIZONA | HARVARD PILGRIM HEALTHCARE |
| 10 | 69793 | OTHER | ARIZONA | CHILDRENS MED SEC PLAN |
| 11 | 90546 | OTHER | ARIZONA | FALLON COMM HEALTH PLAN |
| 12 | A37828 | OTHER | ARIZONA | MEDICARE B |
| 13 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 14 | 042472266 | OTHER | | THREE RIVERS |
| 15 | 2098466 | OTHER | | MEDICAID WELFARE |
| 16 | 042472266 | OTHER | ARIZONA | HEALTHCARE VALUE MGMT |
| 17 | J28266 | OTHER | | BLUE CROSS BLUE SHIELD |
| 18 | 2094514 | OTHER | ARIZONA | FIRST HEALTH |
| 19 | 7241458 | OTHER | ARIZONA | AETNA US HEALTHCARE |
