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 | ME0060739 | 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 | 009957635 | OTHER | ALABAMA | AL. MCAID FWB PROVIDER # |
2 | 25224 | OTHER | FLORIDA | BCBS PROVIDER NUMBER |
3 | 5909067 | OTHER | FLORIDA | AETNA THRU ECHA PROV. NUM |
4 | 009957625 | OTHER | ALABAMA | AL. MCAID CRO PROVIDER # |
5 | P-12004670 | OTHER | FLORIDA | MULTIPLAN PROVIDER NUMBER |
6 | 738889 | OTHER | FLORIDA | FIRST HEALTH PROVIDER NUM |
7 | 375209700 | MEDICAID | FLORIDA | |
8 | 009957645 | OTHER | ALABAMA | AL. MCAID SRB PROVIDER # |
9 | 118455 | OTHER | ALABAMA | ALABAMA MEDICAID CRO 05/01/10 |
10 | 118462 | OTHER | ALABAMA | ALABAMA MEDICAID SRB 05/01/10 |
11 | 36-00905 | OTHER | FLORIDA | UTD. HLTHCR. PROVIDER # |
12 | 373224 | OTHER | FLORIDA | AVMED |
13 | F79337 | MEDICARE UPIN | FLORIDA | |
14 | 009948645 | OTHER | FLORIDA | AL. MCAID PSO PROVIDER # |
15 | 118460 | OTHER | ALABAMA | ALABAMA MEDICAID DSF 05/01/10 |
16 | 226045 | OTHER | FLORIDA | WELLCARE |
17 | 25224A | MEDICARE PIN | FLORIDA | |
18 | P12004670 | OTHER | FLORIDA | MULTIPLAN PROVIDER NUMBER |
19 | 118461 | OTHER | ALABAMA | ALABAMA MEDICAID FWB 05/01/10 |
20 | 0185058 | OTHER | FLORIDA | CIGNA PROVIDER NUMBER |