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 | 2085R0001X | Radiology | Radiation Oncology | ME0087698 | FLORIDA | 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 | 969200 | OTHER | FLORIDA | USA MNGD CR PROVIDER # |
| 2 | 4099573 | OTHER | FLORIDA | GHI PROVIDER NUMBER |
| 3 | 71699Z | MEDICARE PIN | FLORIDA | |
| 4 | 197042 | OTHER | FLORIDA | AMERIGROUP PROVIDER NUM. |
| 5 | 10236 | OTHER | FLORIDA | DIMENSION PROVIDER NUMBER |
| 6 | QMP000003667233 | OTHER | FLORIDA | MOLINA MCD |
| 7 | 71699 | OTHER | FLORIDA | BCBS PROVIDER NUMBER |
| 8 | 7660443 | OTHER | FLORIDA | AETNA PROVIDER NUMBER |
| 9 | H84984 | MEDICARE UPIN | FLORIDA | |
| 10 | 71699Y | MEDICARE PIN | FLORIDA | |
| 11 | 44989 | OTHER | FLORIDA | NHP THRU PMG PROVIDER # |
| 12 | 7660443 | OTHER | FLORIDA | AETNA THRU KEYS PHA |
| 13 | 224345 | OTHER | FLORIDA | WELLCARE PROVIDER NUMBER |
| 14 | 224345 | OTHER | FLORIDA | WELLCARE |
| 15 | P0003149 | OTHER | FLORIDA | FLORIDA HEALTHCARE PLUS |
| 16 | FLPV00003667233 | OTHER | FLORIDA | MOLINA MCR |
| 17 | 289913 | OTHER | FLORIDA | AVMED PROVIDER NUMBER |
| 18 | 267132800 | MEDICAID | FLORIDA | |
| 19 | 7719723 | OTHER | FLORIDA | CIGNA THRU THE KEYS PHA |
| 20 | 289913 | OTHER | FLORIDA | AVMED THRU KEYS PHA |
| 21 | 7719723-003 | OTHER | FLORIDA | CIGNA PROVIDER NUMBER |
| 22 | 8952 | OTHER | FLORIDA | TOTAL HLTH CH. PROVIDER # |
