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 | 207RR0500X | Internal Medicine | Rheumatology | OS10496 | FLORIDA | 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 | 14A3E | OTHER | FLORIDA | BCBS BLUE OPTIONS, BLUE CHOICE, FEDERAL BLUE, FLORIDA STATE, TRADITIONAL BCBS |
| 2 | 59127324 | OTHER | FLORIDA | UHC EMPIRE PLAN |
| 3 | 14A3E | OTHER | FLORIDA | OUT OF STATE BLUE CROSS BLUE SHIELD |
| 4 | 006502500 | MEDICAID | FLORIDA | |
| 5 | GE125Y | MEDICARE PIN | FLORIDA | |
| 6 | GE125Z (LABS ONLY) | MEDICARE PIN | FLORIDA | |
| 7 | 2447922 | OTHER | FLORIDA | FIRST HEALTH AND COVENTRY NATIONAL NETWORK |
| 8 | 591273247 | OTHER | FLORIDA | TRICARE STANDARD |
| 9 | 14A3E | OTHER | FLORIDA | BCBS BLUE CARE, ADVANTAGE 65 SELECT, MEDICARE PPO/HMO, GO BLUE |
| 10 | 6913529 | OTHER | FLORIDA | CIGNA PPO/HMO, OPEN ACCESS AND GREATWEST |
| 11 | 9521897 | OTHER | FLORIDA | AETNA, PPO, HMO, EPO, MANAGED CHOICE, MEDICARE HMO/PPO |
| 12 | 362294 | OTHER | FLORIDA | AVMED |
| 13 | 4039402 | OTHER | | MAIL HANDLERS BENEFIT PLAN (MHBP) |
