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 | 204D00000X | Neuromusculoskeletal Medicine & OMM | | 49644 | COLORADO | No |
| 2 | 207RP1001X | Internal Medicine | Pulmonary Disease | 49644 | COLORADO | No |
| 3 | 207SG0201X | Medical Genetics | Clinical Genetics (M.D.) | 49644 | COLORADO | No |
| 4 | 207K00000X | Allergy & Immunology | | 49644 | COLORADO | No |
| 5 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 49644 | COLORADO | No |
| 6 | 207RE0101X | Internal Medicine | Endocrinology, Diabetes & Metabolism | 49644 | COLORADO | No |
| 7 | 207PS0010X | Emergency Medicine | Sports Medicine | 49644 | COLORADO | Yes |
| 8 | 202D00000X | Integrative Medicine | | 49644 | COLORADO | No |
| 9 | 204C00000X | Neuromusculoskeletal Medicine, Sports Medicine | | 49644 | COLORADO | No |
| 10 | 208200000X | Plastic Surgery | | 49644 | COLORADO | No |
| 11 | 2083T0002X | Preventive Medicine | Medical Toxicology | 49644 | COLORADO | No |
| 12 | 2084P0301X | Psychiatry & Neurology | Brain Injury Medicine | 49644 | COLORADO | No |
| 13 | 2084S0010X | Psychiatry & Neurology | Sports Medicine | 49644 | COLORADO | No |
| 14 | 207XX0005X | Orthopaedic Surgery | Sports Medicine | 49644 | COLORADO | 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 | 021891 | OTHER | COLORADO | KAISER COMMERCIAL NUMBER |
| 2 | 2606406 | MEDICAID | OHIO | |
| 3 | 53888031 | MEDICAID | COLORADO | |
