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 | 311Z00000X | Custodial Care Facility | | | | No |
| 2 | 2085R0001X | Radiology | Radiation Oncology | | | No |
| 3 | 2084N0400X | Psychiatry & Neurology | Neurology | | | No |
| 4 | 207Y00000X | Otolaryngology | | | | No |
| 5 | 207R00000X | Internal Medicine | | | | No |
| 6 | 208VP0000X | Pain Medicine | Pain Medicine | | | No |
| 7 | 207RC0000X | Internal Medicine | Cardiovascular Disease | | | No |
| 8 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | | | No |
| 9 | 2085R0202X | Radiology | Diagnostic Radiology | | | No |
| 10 | 207L00000X | Anesthesiology | | | | No |
| 11 | 207LP2900X | Anesthesiology | Pain Medicine | | | No |
| 12 | 207Q00000X | Family Medicine | | | | Yes |