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 | 2085R0001X | Radiology | Radiation Oncology | ME0073378 | 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 | 170049 | OTHER | FLORIDA | WELLCARE PROVIDER NUMBER |
| 2 | 41696V | MEDICARE PIN | FLORIDA | |
| 3 | 252758800 | MEDICAID | FLORIDA | |
| 4 | FLPV00003667229 | OTHER | FLORIDA | MOLINA MCR |
| 5 | 251555 | OTHER | FLORIDA | AVMED PROVIDER NUMBER |
| 6 | 222166 | OTHER | FLORIDA | AMERIGROUP PROVIDER # |
| 7 | 259097 | OTHER | FLORIDA | AVMED PROVIDER NUMBER |
| 8 | 843672 | OTHER | FLORIDA | USA MNGD. CR. PROVIDER # |
| 9 | 41696Y | MEDICARE PIN | FLORIDA | |
| 10 | 4197468 | OTHER | FLORIDA | GHI PROVIDER NUMBER |
| 11 | 5070616 | OTHER | FLORIDA | AETNA PROVIDER NUMBER |
| 12 | 9137 | OTHER | FLORIDA | DIMENSION PROVIDER NUMBER |
| 13 | 41696X | MEDICARE PIN | FLORIDA | |
| 14 | 41696 | OTHER | FLORIDA | BCBS PROVIDER NUMBER |
| 15 | G50795 | MEDICARE UPIN | FLORIDA | |
| 16 | QMP000003667229 | OTHER | FLORIDA | MOLINA MCD |
| 17 | 1228843 | OTHER | FLORIDA | FIRST HEALTH PROVIDER # |
| 18 | 224268 | OTHER | FLORIDA | WELLCARE |
| 19 | 8790 | OTHER | FLORIDA | TOTAL HLTH CH PROVIDER # |
| 20 | P0003151 | OTHER | FLORIDA | FLORIDA HEALTHCARE PLUS |
