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 | 207X00000X | Orthopaedic Surgery | | 37803 | MINNESOTA | Yes |
| 2 | 207X00000X | Orthopaedic Surgery | | A-1685-12 | NEW MEXICO | No |
| 3 | 207XS0106X | Orthopaedic Surgery | Hand Surgery | 37803 | MINNESOTA | No |
| 4 | 207XS0106X | Orthopaedic Surgery | Hand Surgery | A-1685-12 | NEW MEXICO | No |
| 5 | 207XS0114X | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 37803 | MINNESOTA | No |
| 6 | 207XS0114X | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | A-1685-12 | NEW MEXICO | No |
| 7 | 207XX0005X | Orthopaedic Surgery | Sports Medicine | 37803 | MINNESOTA | No |
| 8 | 207XX0005X | Orthopaedic Surgery | Sports Medicine | A-1685-12 | NEW MEXICO | No |
| 9 | 207XX0801X | Orthopaedic Surgery | Orthopaedic Trauma | 37803 | MINNESOTA | No |
| 10 | 207XX0801X | Orthopaedic Surgery | Orthopaedic Trauma | A-1685-12 | NEW MEXICO | No |
| 11 | 207XP3100X | Orthopaedic Surgery | Pediatric Orthopaedic Surgery | 37803 | MINNESOTA | No |
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 | 257865YKR1 | MEDICARE UPIN | NEW MEXICO | |
| 2 | C78396 | MEDICARE UPIN | MINNESOTA | |
| 3 | 71551336 | MEDICAID | NEW MEXICO | |
| 4 | 1225018302 | MEDICARE PIN | MINNESOTA | |