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 | 207QA0000X | Family Medicine | Adolescent Medicine | 2006-00475 | NORTH CAROLINA | No |
| 2 | 207QA0401X | Family Medicine | Addiction Medicine | 326033 | LOUISIANA | No |
| 3 | 207QA0401X | Family Medicine | Addiction Medicine | 286296 | MASSACHUSETTS | No |
| 4 | 207QA0401X | Family Medicine | Addiction Medicine | 223824 | NEW YORK | No |
| 5 | 207QA0401X | Family Medicine | Addiction Medicine | 35.140995 | OHIO | No |
| 6 | 207QA0401X | Family Medicine | Addiction Medicine | T9199 | TEXAS | No |
| 7 | 207QA0401X | Family Medicine | Addiction Medicine | MD61123191 | WASHINGTON | No |
| 8 | 207QA0401X | Family Medicine | Addiction Medicine | 206-00475 | NORTH CAROLINA | No |
| 9 | 207Q00000X | Family Medicine | | 2006-00475 | NORTH CAROLINA | 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 | 8907673 | OTHER | NORTH CAROLINA | MEDCAID PHYSICIAN |
| 2 | 235013 | OTHER | NORTH CAROLINA | MEDICARE PHYSICIAN |
| 3 | 014MX | OTHER | NORTH CAROLINA | BCBS LABS |
| 4 | 07673 | OTHER | NORTH CAROLINA | BCBS PHYSICIAN |
| 5 | 34U011 | OTHER | NORTH CAROLINA | MEDICARE SWINGBED |
| 6 | 235013B | OTHER | NORTH CAROLINA | MEDICARE PHYSICIAN |
| 7 | 00513 | OTHER | NORTH CAROLINA | BCBS |
| 8 | 3400011 | OTHER | NORTH CAROLINA | MEDCAID |
| 9 | 411013849 | OTHER | NORTH CAROLINA | MEDICARE RAILROAD |
| 10 | 0081P | OTHER | NORTH CAROLINA | BCBS SWINGBED |
