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 | 207RS0012X | Internal Medicine | Sleep Medicine | M1780 | TEXAS | No |
| 2 | 2084N0400X | Psychiatry & Neurology | Neurology | M1780 | TEXAS | 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 | 00659N | OTHER | TEXAS | MHS PHYS OF TX GRP PTAN - MONTGOMERY COUNTY |
| 2 | 153449704 | OTHER | TEXAS | MHS PHYS OF TX MEDICAID GRP TPI - HARRIS COUNTY |
| 3 | 153449706 | OTHER | TEXAS | MHS PHYS OF TX MEDICAID GRP TPI - MONTGOMERY COUNTY |
| 4 | 351187YNBT | OTHER | TEXAS | MDCR PTAN MONTGOMERY CO. |
| 5 | 351179YNBT | OTHER | TEXAS | MDCR PTAN |
| 6 | 8F0941 | MEDICARE ID-TYPE UNSPECIFIED | TEXAS | |
| 7 | I39485 | MEDICARE UPIN | TEXAS | |
| 8 | 00106W | OTHER | TEXAS | MHS PHYS OF TX GRP PTAN - HARRIS COUNTY |
| 9 | 0035TD | OTHER | TEXAS | MHS PHYS OF TX BCBSTX GRP PROV REC # |
