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 | 2085R0001X | Radiology | Radiation Oncology | ME0047908 | 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 | 0053977-017 | OTHER | FLORIDA | CIGNA PROVIDER NUMBER |
| 2 | 920004623 | OTHER | FLORIDA | RAILROAD MEDICARE |
| 3 | ME47908A | OTHER | FLORIDA | METCARE PROVIDER ID # |
| 4 | 592485899 | OTHER | FLORIDA | METCARE VENDOR ID # |
| 5 | 73297 | OTHER | FLORIDA | BCBS PROVIDER NUMBER |
| 6 | 00788 | OTHER | FLORIDA | UNV. HLTHCR. PROVIDER # |
| 7 | D58315 | MEDICARE UPIN | FLORIDA | |
| 8 | 90546 | OTHER | FLORIDA | FIRST HEALTH PROVIDER NUM |
| 9 | 24-05257 | OTHER | FLORIDA | UHC PROVIDER NUMBER |
| 10 | 4129691 | OTHER | FLORIDA | AETNA OTHER PROVIDER NUM. |
| 11 | 73297Y | MEDICARE PIN | FLORIDA | |
| 12 | 0624230 | OTHER | FLORIDA | AETNA HMO PROVIDER NUMBER |
| 13 | 85445 | OTHER | FLORIDA | OP. ENG. LOC. 825 PROV. # |
| 14 | 202575 | OTHER | FLORIDA | AVMED PROVIDER NUMBER |
| 15 | 273709 | OTHER | FLORIDA | GREAT WEST REFERENCE NUM. |
| 16 | 045283100 | MEDICAID | FLORIDA | |
