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 | 207RI0011X | Internal Medicine | Interventional Cardiology | | | No |
| 2 | 207U00000X | Nuclear Medicine | | | | No |
| 3 | 207UN0902X | Nuclear Medicine | Nuclear Imaging & Therapy | | | No |
| 4 | 207ZH0000X | Pathology | Hematology | | | No |
| 5 | 207ZI0100X | Pathology | Immunopathology | | | No |
| 6 | 207ZM0300X | Pathology | Medical Microbiology | | | No |
| 7 | 2085B0100X | Radiology | Body Imaging | | | No |
| 8 | 2085N0904X | Radiology | Nuclear Radiology | | | No |
| 9 | 2085R0202X | Radiology | Diagnostic Radiology | | | Yes |
| 10 | 2085R0204X | Radiology | Vascular & Interventional Radiology | | | No |
| 11 | 2085U0001X | Radiology | Diagnostic Ultrasound | | | No |
| 12 | 208D00000X | General Practice | | | | No |
| 13 | 207RS0012X | Internal Medicine | Sleep Medicine | | | No |
| 14 | 2085D0003X | Radiology | Diagnostic Neuroimaging | | | 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 | 268401200 | MEDICAID | FLORIDA | |
| 2 | ========= | OTHER | | CIGNA |
| 3 | ========= | OTHER | | COVENTRY HEALTH CARE OF FLORIDA |
| 4 | F00242041801 | OTHER | | NEIGHBORHOOD HEALTH |
| 5 | ========= | OTHER | | JMH HEALTH PLAN |
| 6 | ========= | OTHER | | MULTIPLAN |
| 7 | 2420418 | OTHER | | UNITED |
| 8 | ========= | OTHER | | GREAT WEST |
| 9 | ========= | OTHER | | PRIVATE HEALTHCARE SYSTEMS |
| 10 | 1512 | OTHER | FLORIDA | MEDICA |
| 11 | 285239 | OTHER | FLORIDA | AVMED |
| 12 | 3161380 | OTHER | | AETNA HMO |
| 13 | 16-03678 | OTHER | | UNITED MEDICARE |
| 14 | ========= | OTHER | | COVENTRY PPO |
| 15 | ========= | OTHER | | FIRST HEALTH |
| 16 | 1512 | OTHER | | MEDICA |
| 17 | 8202105 | OTHER | FLORIDA | AETNA NON HMO |
| 18 | ========= | OTHER | | BEECH STREET |
| 19 | ========= | OTHER | | HUMANA CHOICE |
| 20 | 97694 | OTHER | | BLUE CROSS BLUE SHIELD |
| 21 | ========= | OTHER | | CORVEL |
| 22 | ========= | OTHER | | COVENTRY HEALTH PLAN OF FLORIDA |
| 23 | ========= | OTHER | | DIMENSION |
| 24 | ========= | OTHER | | TRICARE |
