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 | 207R00000X | Internal Medicine | | MD5868 | HAWAII | No |
| 2 | 207P00000X | Emergency Medicine | | MD5868 | HAWAII | No |
| 3 | 207P00000X | Emergency Medicine | | MD150758 | OREGON | No |
| 4 | 207P00000X | Emergency Medicine | | 0350 | MARIANA ISLANDS | No |
| 5 | 207P00000X | Emergency Medicine | | ME59448 | FLORIDA | No |
| 6 | 207P00000X | Emergency Medicine | | ME59448 | NEW JERSEY | No |
| 7 | 207R00000X | Internal Medicine | | MD150758 | OREGON | No |
| 8 | 207R00000X | Internal Medicine | | 0350 | MARIANA ISLANDS | No |
| 9 | 207R00000X | Internal Medicine | | ME59448 | FLORIDA | No |
| 10 | 207R00000X | Internal Medicine | | MA40955 | NEW JERSEY | No |
| 11 | 2083P0011X | Preventive Medicine | Undersea and Hyperbaric Medicine | MD150758 | OREGON | No |
| 12 | 2083P0011X | Preventive Medicine | Undersea and Hyperbaric Medicine | ME59448 | FLORIDA | No |
| 13 | 2083P0011X | Preventive Medicine | Undersea and Hyperbaric Medicine | ME59448 | NEW JERSEY | No |
| 14 | 2083P0011X | Preventive Medicine | Undersea and Hyperbaric Medicine | 0350 | MARIANA ISLANDS | No |
| 15 | 2083P0011X | Preventive Medicine | Undersea and Hyperbaric Medicine | MD5868 | HAWAII | 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 | C9609 | MEDICARE UPIN | GUAM | |
| 2 | R158437 | MEDICARE PIN | OREGON | |
| 3 | 0000ZGBDG | OTHER | OREGON | CURRY GENERAL HOSPITAL - MEDICARE PART B |
| 4 | 381322 | OTHER | OREGON | CURRY GENERAL HOSPITAL - MEDICARE PART A |
| 5 | 500630865 | MEDICAID | OREGON | |