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 | ME0050654 | 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 | 1100418 | OTHER | FLORIDA | CAREPLUS |
| 2 | 3810001729 | MEDICAID | WEST VIRGINIA | |
| 3 | 4167153 | MEDICARE PIN | WEST VIRGINIA | |
| 4 | 32473 | OTHER | FLORIDA | UNIVERSAL HEALTHCARE |
| 5 | 09268 | OTHER | FLORIDA | BCBS PROVIDER NUMBER |
| 6 | P00914308 | OTHER | WEST VIRGINIA | RAILROAD MEDICARE |
| 7 | P300324 | OTHER | FLORIDA | FREEDOM |
| 8 | 4167152 | MEDICARE PIN | WEST VIRGINIA | |
| 9 | 1598760936 | MEDICAID | VIRGINIA | |
| 10 | P01054735 | OTHER | FLORIDA | RAILROAD MCR |
| 11 | WV14877A (KATIN) | OTHER | WEST VIRGINIA | THE HEALTH PLAN OF THE UPPER OHIO VALLEY |
| 12 | WV14877B (WVRTSI) | OTHER | WEST VIRGINIA | THE HEALTH PLAN OF THE UPPER OHIO VALLEY |
| 13 | 2590714 | OTHER | WEST VIRGINIA | CIGNA (WVRTSI) |
| 14 | 268532900 | MEDICAID | FLORIDA | |
| 15 | 09268T | MEDICARE PIN | FLORIDA | |
| 16 | 09268V | MEDICARE PIN | FLORIDA | |
| 17 | 4235301 | OTHER | WEST VIRGINIA | AETNA |
| 18 | P00924622 | OTHER | WEST VIRGINIA | RAILROAD MEDICARE (KATIN) |
| 19 | 152082 | OTHER | FLORIDA | WELLCARE |
| 20 | 212174 | OTHER | FLORIDA | AVMED |
| 21 | 23878 | OTHER | FLORIDA | FIRST HEALTH PROVIDER # |
| 22 | 2590714 | OTHER | WEST VIRGINIA | CIGNA (KATIN) |
| 23 | 2595278 | OTHER | WEST VIRGINIA | HIGHMARK BCBS WV |
| 24 | C67526 | MEDICARE UPIN | FLORIDA | |
