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 | 208000000X | Pediatrics | | ME68044 | 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 | 160274001 | OTHER | TEXAS | TEXAS MEDICAID |
| 2 | 160461 | OTHER | | HEALTHEASE HEALTH 1ST |
| 3 | 32119 | OTHER | FLORIDA | PREFERRED PATIENT CARE |
| 4 | 5173714 | OTHER | | AETNA US HEALTHCARE |
| 5 | 32119 | OTHER | | HEALTH OPTIONS |
| 6 | 5173714 | OTHER | | AETNA |
| 7 | Q68044 | OTHER | | DEPARTMENT OF PHYS SE |
| 8 | 1206338 | OTHER | FLORIDA | UNITED HEALTHCARE |
| 9 | 4878883 | OTHER | FLORIDA | CIGNA INTERNATIONAL |
| 10 | 5173714 | OTHER | | AETNA CONTAINER |
| 11 | 593216460 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 12 | 009905570 | OTHER | ALABAMA | ALACAID |
| 13 | 4878883 | OTHER | FLORIDA | CIGNA HEALTHCARE |
| 14 | 59109002 | OTHER | ALABAMA | BLUE CROSS AND BLUE SHIELD OF ALABAMA |
| 15 | 660022102 | MEDICAID | FLORIDA | |
| 16 | 015443 | OTHER | | PCA FAMILY HEALTH PLAN |
| 17 | 32119 | OTHER | FLORIDA | BLUE CROSS AND BLUE SHIELD OF FLORIDA |
| 18 | 541900103 | OTHER | ALABAMA | ALACAID |
| 19 | 660022100 | MEDICAID | FLORIDA | |
| 20 | 1206338 | OTHER | | AARP HEALTHCARE UNITED |
| 21 | 5173714 | OTHER | FLORIDA | AETNA GLOBAL BENEFITS |
| 22 | 5173714 | OTHER | FLORIDA | AETNA US HEALTHCARE |
| 23 | 051359 | OTHER | FLORIDA | VISTA |
| 24 | 32119 | OTHER | FLORIDA | HEALTH 1ST NETWORK |
| 25 | 541009001 | OTHER | | ALACAID |
| 26 | 59176907 | OTHER | ALABAMA | BLUE CROSS AND BLUE SHIELD OF ALABAMA |
| 27 | 251076600 | MEDICAID | FLORIDA | |
| 28 | 5173714 | OTHER | | AETNA LIFE INS CO |
