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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | ME64582 | FLORIDA | No |
| 2 | 207RI0011X | Internal Medicine | Interventional Cardiology | ME64582 | 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 | 060039486 | OTHER | FLORIDA | RAILROAD MEDICARE |
| 2 | 1090291 | OTHER | FLORIDA | UNITED H'CARE PROV ID # |
| 3 | 196550 | OTHER | FLORIDA | STAYWELL MCD PROV ID # |
| 4 | 373499400 | MEDICAID | FLORIDA | |
| 5 | 196550 | OTHER | FLORIDA | HEALTHESE MCD PROV ID # |
| 6 | 2171130012 | OTHER | FLORIDA | CIGNA PROV ID # |
| 7 | 4411299 | OTHER | FLORIDA | AETNA PRO ID |
| 8 | 72852 | OTHER | FLORIDA | FIRST HEALTH PROV ID # |
| 9 | 12650 | OTHER | FLORIDA | FHHS PROV ID # |
| 10 | 273066 | OTHER | FLORIDA | GREAT WEST PROV ID # |
| 11 | 386222 | OTHER | FLORIDA | HUMANA PROV ID # |
| 12 | 196550 | OTHER | FLORIDA | WELLCARE PROV ID # |
| 13 | 208683 | OTHER | FLORIDA | AMERIGROUP MCD PROV ID # |
| 14 | 23141 | OTHER | FLORIDA | BCBS OF FL PROV ID # |