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 | 2083P0901X | Preventive Medicine | Public Health & General Preventive Medicine | ME141497 | FLORIDA | Yes |
| 2 | 2083X0100X | Preventive Medicine | Occupational Medicine | A165176 | CALIFORNIA | No |
| 3 | 2083X0100X | Preventive Medicine | Occupational Medicine | D0088242 | MARYLAND | No |
| 4 | 2083X0100X | Preventive Medicine | Occupational Medicine | 59141 | ARIZONA | No |
| 5 | 2083X0100X | Preventive Medicine | Occupational Medicine | 01078523A | INDIANA | No |
| 6 | 2083X0100X | Preventive Medicine | Occupational Medicine | 38550 | ALABAMA | No |
| 7 | 2083X0100X | Preventive Medicine | Occupational Medicine | 150879 | ALASKA | No |
| 8 | 2083X0100X | Preventive Medicine | Occupational Medicine | MD468233 | PENNSYLVANIA | No |
| 9 | 2083X0100X | Preventive Medicine | Occupational Medicine | 53070 | KENTUCKY | No |
| 10 | 2083X0100X | Preventive Medicine | Occupational Medicine | 4301500489 | MICHIGAN | No |
| 11 | 2083X0100X | Preventive Medicine | Occupational Medicine | E-12568 | ARKANSAS | No |
| 12 | 208D00000X | General Practice | | 28795 | WEST VIRGINIA | No |
| 13 | 390200000X | Student in an Organized Health Care Education/Training Program | | | | No |
| 14 | 2083X0100X | Preventive Medicine | Occupational Medicine | 0101267722 | VIRGINIA | No |
| 15 | 2083X0100X | Preventive Medicine | Occupational Medicine | 83897 | GEORGIA | 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 | 01078523A | OTHER | INDIANA | LICENSE |
| 2 | 281631 | OTHER | MASSACHUSETTS | STATE LICENSE |
| 3 | M-14856 | OTHER | IDAHO | STATE LICENSE |
| 4 | MD16846 | OTHER | RHODE ISLAND | STATE LICENSE |
| 5 | 150879 | OTHER | ALASKA | STATE LICENSE |
| 6 | 16110 | OTHER | NORTH DAKOTA | STATE LICENSE |
| 7 | 32094 | OTHER | NEBRASKA | STATE LICENSE |
| 8 | 66243 | OTHER | MINNESOTA | STATE LICENSE |
| 9 | MD195637 | OTHER | OREGON | STATE LICENSE |
| 10 | MD20739 | OTHER | HAWAII | STATE LICENSE |
| 11 | S3935 | OTHER | TEXAS | STATE LICENSE |
| 12 | 19979 | OTHER | NEW HAMPSHIRE | STATE LICENSE |
| 13 | A165176 | OTHER | CALIFORNIA | STATE LICENSE |
| 14 | MD-46545 | OTHER | IOWA | STATE LICENSE |
| 15 | MD60972416 | OTHER | WASHINGTON | STATE LICENSE |
| 16 | ME141497 | OTHER | FLORIDA | LICENSE |
| 17 | 300527 | OTHER | NEW YORK | STATE LICENSE |
| 18 | 35092 | OTHER | OKLAHOMA | STATE LICENSE |
| 19 | 38550 | OTHER | ALABAMA | LICENSE |
| 20 | 4301500489 | OTHER | MICHIGAN | STATE LICENSE |
| 21 | 83897 | OTHER | GEORGIA | GEORGIA |
| 22 | MD048607 | OTHER | DISTRICT OF COLUMBIA | STATE LICENSE |
| 23 | 11351098-1205 | OTHER | UTAH | STATE LICENSE |
| 24 | 20824 | OTHER | NEVADA | STATE LICENSE |
| 25 | 320861 | OTHER | LOUISIANA | STATE LICENSE |
| 26 | 35.136962CTR | OTHER | OHIO | STATE LICENSE |
| 27 | C1-0013395 | OTHER | DELAWARE | STATE LICENSE |
| 28 | MD2019-0869 | OTHER | NEW MEXICO | STATE LICENSE |
| 29 | 12446A | OTHER | WYOMING | STATE LICENSE |
| 30 | 2019-01958 | OTHER | NORTH CAROLINA | LICENSE |
| 31 | 25MA10667900 | OTHER | NEW JERSEY | STATE LICENSE |
| 32 | 53070 | OTHER | KENTUCKY | STATE LICENSE |
| 33 | 71877-20 | OTHER | WISCONSIN | STATE LICENSE |
| 34 | 82992 | OTHER | SOUTH CAROLINA | STATE LICENSE |
| 35 | E-12568 | OTHER | ARKANSAS | STATE LICENSE |
| 36 | MED-PHYS-LIC87942 | OTHER | MONTANA | STATE LICENSE |
| 37 | 0101267722 | OTHER | VIRGINIA | STATE LICENSE |
| 38 | 036150640 | OTHER | ILLINOIS | STATE LICENSE |
| 39 | 04-42551 | OTHER | KANSAS | STATE LICENSE |
| 40 | 59141 | OTHER | ARIZONA | LICENSE |
| 41 | D0088242 | OTHER | MARYLAND | STATE LICENSE |
| 42 | MD23245 | OTHER | MAINE | STATE LICENSE |
| 43 | 12115 | OTHER | SOUTH DAKOTA | STATE LICENSE |
| 44 | 2019024778 | OTHER | MISSOURI | STATE LICENSE |
| 45 | 27184 | OTHER | MISSISSIPPI | STATE LICENSE |
| 46 | 28795 | OTHER | WEST VIRGINIA | STATE LICENSE |
| 47 | 59945 | OTHER | TENNESSEE | STATE LICENSE |
| 48 | DR.0062841 | OTHER | COLORADO | STATE LICENSE |
| 49 | MD468233 | OTHER | PENNSYLVANIA | STATE LICENSE |
| 50 | ME141497 | OTHER | FLORIDA | FLORIDA |
