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 | 207RG0300X | Internal Medicine | Geriatric Medicine | ME81127 | 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 | 00780 | OTHER | FLORIDA | UNIVERSAL ID |
| 2 | 2795817 00 | MEDICAID | FLORIDA | |
| 3 | G78647 | MEDICARE UPIN | FLORIDA | |
| 4 | E5364W | MEDICARE PIN | FLORIDA | |
| 5 | 7572308 | OTHER | LOUISIANA | CIGNA ID |
| 6 | 123192 | OTHER | FLORIDA | HUMANA ID |
| 7 | 7128124 | OTHER | FLORIDA | AETNA ID |
| 8 | ME81127 | OTHER | FLORIDA | MEDICAL LICENSE NUMBER |
| 9 | 1988649 | OTHER | FLORIDA | UNITED HEALTHCARE ID |
| 10 | 06055 | OTHER | FLORIDA | BLUE CROSS BLUE SHIELD ID |
| 11 | 28922 | OTHER | FLORIDA | AVMED ID |
| 12 | 5589903 | OTHER | FLORIDA | FIRST HEALTH |
| 13 | 241506 | OTHER | FLORIDA | WELLCARE ID |
| 14 | 352728686 | OTHER | FLORIDA | TRICARE ID |
| 15 | 125028 | OTHER | FLORIDA | HUMANA GOLD PLUS ID |
