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 | 174400000X | Specialist | | ME74679 | 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 | EFFECTIVE 07/14/208 | OTHER | | COALITION AMERICA/NPPN |
| 2 | EFFECTIVE 11/01/2007 | OTHER | | COVENTRY |
| 3 | EFFECTIVE 10/30/2008 | OTHER | | TRICARE |
| 4 | 458713 | OTHER | | WELLCARE |
| 5 | 01226797 | OTHER | FLORIDA | AMERIGROUP |
| 6 | 1033065 | OTHER | | CAREPLUS HEALTH PLAN |
| 7 | 2580722 | OTHER | | BEECHSTREET NETWORK |
| 8 | 44932 | OTHER | FLORIDA | BCBS OF FLORIDA |
| 9 | EFFECTIVE 10/20/2008 | OTHER | | CIGNA |
| 10 | EFFECTIVE 12/29/2008 | OTHER | | HUMANA CHOICE CARE |
| 11 | EFFECTIVE 01/01/2009 | OTHER | | ACCOUNTABLE/INTERPLAN HEALTH GROUP |
| 12 | EFFECTIVE 10/01/2008 | OTHER | | UNITEDHEALTHCARE |
| 13 | 7381303 | OTHER | | AETNA PPO |
| 14 | 6684138 | OTHER | | AETNA HMO |
| 15 | EFFECTIVE 08/07/2008 | OTHER | | EVOLUTIONS |
| 16 | EFFECTIVE 10/23/08 | OTHER | | MULTIPLAN/PHCS |
