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 | 208600000X | Surgery | | 0101277434 | VIRGINIA | No |
| 2 | 208600000X | Surgery | | 25MA11443500 | NEW JERSEY | No |
| 3 | 2086S0102X | Surgery | Surgical Critical Care | 23626 | NEBRASKA | No |
| 4 | 2086S0102X | Surgery | Surgical Critical Care | 25MA11443500 | NEW JERSEY | No |
| 5 | 2086S0120X | Surgery | Pediatric Surgery | 25MA11443500 | NEW JERSEY | No |
| 6 | 2086S0120X | Surgery | Pediatric Surgery | T7790 | TEXAS | No |
| 7 | 2086X0206X | Surgery | Surgical Oncology | 23626 | NEBRASKA | No |
| 8 | 2086X0206X | Surgery | Surgical Oncology | 25MA11443500 | NEW JERSEY | No |
| 9 | 2086S0120X | Surgery | Pediatric Surgery | 2024040742 | MISSOURI | 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 | 30422 | OTHER | NEBRASKA | BCBS |
| 2 | 17-01116 | OTHER | | UHC |
| 3 | 0721167 | MEDICAID | IOWA | |
| 4 | 250578 | OTHER | | MIDLANDS CHOICE |
