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 | 207NI0002X | Dermatology | Clinical & Laboratory Dermatological Immunology | | | No |
| 2 | 207RE0101X | Internal Medicine | Endocrinology, Diabetes & Metabolism | | | No |
| 3 | 261QD0000X | Clinic/Center | Dental | | | No |
| 4 | 302R00000X | Health Maintenance Organization | | | | No |
| 5 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | | No |
| 6 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 7 | 261QP2000X | Clinic/Center | Physical Therapy | | | No |
| 8 | 207RI0001X | Internal Medicine | Clinical & Laboratory Immunology | | | No |
| 9 | 261QP2300X | Clinic/Center | Primary Care | | | No |
| 10 | 208D00000X | General Practice | | | | Yes |