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 | 207K00000X | Allergy & Immunology | | | | No |
| 2 | 207P00000X | Emergency Medicine | | | | No |
| 3 | 207R00000X | Internal Medicine | | | | No |
| 4 | 208000000X | Pediatrics | | | | No |
| 5 | 208100000X | Physical Medicine & Rehabilitation | | | | No |
| 6 | 2083P0500X | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine | | | No |
| 7 | 2083X0100X | Preventive Medicine | Occupational Medicine | | | No |
| 8 | 2084A0401X | Psychiatry & Neurology | Addiction Medicine | | | No |
| 9 | 2084P2900X | Psychiatry & Neurology | Pain Medicine | | | No |
| 10 | 208D00000X | General Practice | | | | No |
| 11 | 208VP0000X | Pain Medicine | Pain Medicine | | | No |
| 12 | 208VP0014X | Pain Medicine | Interventional Pain Medicine | | | No |
| 13 | 363A00000X | Physician Assistant | | | | No |
| 14 | 363L00000X | Nurse Practitioner | | | | No |
| 15 | 207Q00000X | Family Medicine | | | | Yes |