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 | 208D00000X | General Practice | | 68057 | Foreign Country | No |
| 2 | 208D00000X | General Practice | | 34024 | SOUTH CAROLINA | No |
| 3 | 208D00000X | General Practice | | 52580-20 | WISCONSIN | Yes |
| 4 | 2083C0008X | Preventive Medicine | Clinical Informatics | 52580-20 | WISCONSIN | No |
| 5 | 2083C0008X | Preventive Medicine | Clinical Informatics | 34024 | SOUTH CAROLINA | No |
| 6 | 2083P0901X | Preventive Medicine | Public Health & General Preventive Medicine | 34024 | SOUTH CAROLINA | No |
| 7 | 2083P0901X | Preventive Medicine | Public Health & General Preventive Medicine | 52580-20 | WISCONSIN | No |
| 8 | 202D00000X | Integrative Medicine | | 34024 | SOUTH CAROLINA | No |
| 9 | 207Q00000X | Family Medicine | | 34024 | SOUTH CAROLINA | No |
| 10 | 207R00000X | Internal Medicine | | 34024 | SOUTH CAROLINA | No |
| 11 | 207R00000X | Internal Medicine | | 52580-20 | WISCONSIN | No |
| 12 | 208000000X | Pediatrics | | 34024 | SOUTH CAROLINA | No |
