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 | 204D00000X | Neuromusculoskeletal Medicine & OMM | | | | No |
| 2 | 207R00000X | Internal Medicine | | | | Yes |
| 3 | 208600000X | Surgery | | | | No |
| 4 | 251B00000X | Case Management | | | | No |
| 5 | 251E00000X | Home Health | | | | No |
| 6 | 251J00000X | Nursing Care | | | | No |
| 7 | 261QA1903X | Clinic/Center | Ambulatory Surgical | | | No |
| 8 | 261QI0500X | Clinic/Center | Infusion Therapy | | | No |
| 9 | 261QM1300X | Clinic/Center | Multi-Specialty | | | No |
| 10 | 261QP2300X | Clinic/Center | Primary Care | | | No |
| 11 | 261QP3300X | Clinic/Center | Pain | | | No |
| 12 | 261QU0200X | Clinic/Center | Urgent Care | | | No |
| 13 | 291U00000X | Clinical Medical Laboratory | | | | No |
| 14 | 332B00000X | Durable Medical Equipment & Medical Supplies | | | | No |
| 15 | 3336C0002X | Pharmacy | Clinic Pharmacy | | | No |