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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 24327 | ARIZONA | 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 | 0143348 | OTHER | WASHINGTON | STATE OF WA DEPT OF LABOR |
| 2 | 10055687 | OTHER | ARIZONA | PPO NEXT |
| 3 | 1172298 00 | MEDICAID | WYOMING | |
| 4 | 1Z3634 | OTHER | ARIZONA | HEALTH NET |
| 5 | XPY196923 | MEDICAID | CALIFORNIA | |
| 6 | 1033508 | OTHER | ARIZONA | FIRST HEALTH |
| 7 | 25-00275 | OTHER | ARIZONA | UNITED HEALTHCARE |
| 8 | 351057 | MEDICAID | ARIZONA | |
| 9 | 5132491 | OTHER | ARIZONA | AETNA |
| 10 | 102612 | OTHER | ARIZONA | PREFERRED HEALTH NETWORK |
| 11 | 8274243 | OTHER | WASHINGTON | STATE OF WA HLTH & SOC SR |
| 12 | 100666 | OTHER | ARIZONA | ONE HEALTH |
| 13 | 2198525 | OTHER | ARIZONA | GHI |
| 14 | 5073466 | OTHER | ARIZONA | CCN |
| 15 | AZ0860310 | OTHER | ARIZONA | BCBS OF ARIZONA |
| 16 | 005502491 | OTHER | ARIZONA | CIGNA |
| 17 | 060057126 | OTHER | ARIZONA | RAILROAD MEDICARE |