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 | 207W00000X | Ophthalmology | | 3688 | ALABAMA | 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 | 510-10235 | OTHER | ALABAMA | BC-2003 MEDICAL CENTER DR, BAY MINETTE |
| 2 | 515-47032 | OTHER | ALABAMA | BC-6144 A AIRPORT BLVD |
| 3 | 515-47835 | OTHER | ALABAMA | BC-6801 AIRPORT BLVD, MOBILE |
| 4 | 510-10218 | OTHER | ALABAMA | BC-1811 HAND AVE, BAY MINETTE |
| 5 | 1578593653 | MEDICAID | ALABAMA | |
| 6 | 51519305 | MEDICARE PIN | ALABAMA | |
| 7 | 699543 | OTHER | ALABAMA | FIRST HEALTH |
| 8 | 510-10216 | OTHER | ALABAMA | BC-7101 US HWY 90, DAPHNE |
| 9 | 515-47834 | OTHER | ALABAMA | BC-1815 HAND AVE, BAY MINETTE |
| 10 | 515-47836 | OTHER | ALABAMA | BC-5 MOBILE INFIRMARY CIRCLE, MOBILE |
| 11 | 515-47837 | OTHER | ALABAMA | BC-3719 DAUPHIN ST, MOBILE |
| 12 | P00085469 | OTHER | | RR MEDICARE PGBA |
| 13 | C75158 | OTHER | ALABAMA | SENIORS FIRST |
| 14 | 051519305 | MEDICAID | ALABAMA | |
| 15 | 1578593653 | MEDICARE PIN | ALABAMA | |
| 16 | 051519305 | OTHER | ALABAMA | BCBS |
| 17 | 0810058 | OTHER | ALABAMA | UNITED HEALTHCARE |
| 18 | 515-19305 | OTHER | ALABAMA | BC-3290 DAUPHIN ST, SUITE 401, MOBILE |
| 19 | 051519305 | MEDICARE PIN | ALABAMA | |
| 20 | C75158 | OTHER | ALABAMA | HEALTHSPRING |
| 21 | C75158 | OTHER | ALABAMA | VIVA |
| 22 | 515-47838 | OTHER | ALABAMA | BC-750 MORPHY AVE, FAIRHOPE |
| 23 | 770610758 | OTHER | ALABAMA | HEALTHCHOICE |
| 24 | C75158 | MEDICARE UPIN | | |