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 | 207Q00000X | Family Medicine | | ME89102 | 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 | P00368813 | OTHER | FLORIDA | RAILROAD MEDICARE |
2 | 59180291 | OTHER | ALABAMA | BLUE CROSS AND BLUE SHIELD OF ALABAMA |
3 | 01512 | MEDICARE PIN | FLORIDA | |
4 | W560 | OTHER | FLORIDA | WELLCARE |
5 | 2357174 | OTHER | FLORIDA | CIGNA INTERNATIONAL |
6 | 272533900 | MEDICAID | FLORIDA | |
7 | 660022100 | MEDICAID | FLORIDA | |
8 | 01512 | OTHER | FLORIDA | HEALTH 1ST NETWORK, INC. |
9 | 7839652 | OTHER | FLORIDA | AETNA US HEALTHCARE |
10 | 2553182 | OTHER | FLORIDA | UNITED HEALTHCARE |
11 | 2553182 | OTHER | FLORIDA | UNITED HEALTCHARE |
12 | 103858 | MEDICARE OSCAR/CERTIFICATION | FLORIDA | |
13 | 009996365 | OTHER | ALABAMA | ALACAID |
14 | 01512 | OTHER | FLORIDA | PREFERRED PATIENT CARE |
15 | I39377 | OTHER | FLORIDA | VISTA |
16 | 2357174 | OTHER | FLORIDA | CIGNA HEALTHCARE |
17 | 593216460A06 | OTHER | FLORIDA | MEDICAL MUTUAL |
18 | 01512 | OTHER | FLORIDA | BCBS OF FLORIDA |
19 | 7839652 | OTHER | FLORIDA | AETNA |
20 | 541900106 | OTHER | ALABAMA | ALACAID |
21 | 01512 | OTHER | FLORIDA | ADVANTAGE 65 |
22 | 7839652 | OTHER | FLORIDA | AETNA GLOBAL BENEFITS |
23 | 21333 | OTHER | FLORIDA | BCBS OF FLORIDA |
24 | 2553182 | OTHER | FLORIDA | DEFINITY HEALTH CLAIMS |
25 | I39377 | MEDICARE UPIN | | |
26 | 21333 | OTHER | FLORIDA | BLUE MEDICARE ADVANTAGE |
27 | 660022102 | MEDICAID | FLORIDA | |