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 | 207XX0005X | Orthopaedic Surgery | Sports Medicine | 12162306-1205 | UTAH | No |
| 2 | 207XX0005X | Orthopaedic Surgery | Sports Medicine | DR.0049619 | COLORADO | No |
| 3 | 2086S0102X | Surgery | Surgical Critical Care | DR.0049619 | COLORADO | No |
| 4 | 2086S0102X | Surgery | Surgical Critical Care | 12162306-1205 | UTAH | No |
| 5 | 207XS0117X | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | DR.0049619 | COLORADO | No |
| 6 | 207T00000X | Neurological Surgery | | DR.0049619 | COLORADO | No |
| 7 | 207XS0117X | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 12162306-1205 | UTAH | No |
| 8 | 207X00000X | Orthopaedic Surgery | | 12162306-1205 | UTAH | No |
| 9 | 207X00000X | Orthopaedic Surgery | | DR.0049619 | COLORADO | No |
| 10 | 208VP0014X | Pain Medicine | Interventional Pain Medicine | 12162306-1205 | UTAH | No |
| 11 | 208VP0014X | Pain Medicine | Interventional Pain Medicine | DR.0049619 | COLORADO | No |
| 12 | 207T00000X | Neurological Surgery | | 12162306-1205 | UTAH | Yes |