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 | 207RR0500X | Internal Medicine | Rheumatology | | | 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 | =========014 | OTHER | NORTH CAROLINA | TRICARE EFFECTIVE 7/1/07 |
| 2 | 019FY | OTHER | NORTH CAROLINA | BCBS EFF 7-1-07 |
| 3 | 355573 | OTHER | NORTH CAROLINA | MAMSI GROUP NUMBER |
| 4 | DF8926 | OTHER | NORTH CAROLINA | RAILROAD MEDICARE PTAN |
| 5 | 2325363 | MEDICARE PIN | NORTH CAROLINA | |
| 6 | 232009 | MEDICARE PIN | NORTH CAROLINA | |
| 7 | 0272K | OTHER | NORTH CAROLINA | BCBS EFF PRIOR TO 7-1-07 |
| 8 | 566000156040 | OTHER | NORTH CAROLINA | TRICARE STANDARD, NON NWK |
| 9 | CC2854 | OTHER | NORTH CAROLINA | RAILROAD MEDICARE GRP |
| 10 | 7115 | OTHER | NORTH CAROLINA | PARTNERS MEDICARE CHOICE |
| 11 | 5906974 | MEDICAID | NORTH CAROLINA | |
