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 | 207K00000X | Allergy & Immunology | | | | 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 | 258780808 | OTHER | | TRICARE STANDARD |
| 2 | 304868 | OTHER | | WELLCARE |
| 3 | 535026 | OTHER | | BCBS POS |
| 4 | 535026 | OTHER | | BCBS GA PPO |
| 5 | 535026 | OTHER | | BCBS FED |
| 6 | 535025 | OTHER | | STATE HEALTH BENEFIT P |
| 7 | 535026 | OTHER | | BCBS AL GA |
| 8 | 60036834 | OTHER | | BCBS AL |
| 9 | 60036871 | OTHER | | BCBS AL |
| 10 | 000635203H | OTHER | | PEACH STATE HEALTH PLA |
| 11 | 258780808 | OTHER | | CHAMP VA |
| 12 | 258780808 | OTHER | | TRICARE FOR LIFE |
| 13 | 535026 | OTHER | | BCBS AL ALL KIDS |
| 14 | 00635203H | OTHER | | PEACHCARE FOR KIDS |
| 15 | 535026 | OTHER | | BCBS HMO |
| 16 | 535026 | OTHER | | BCBS GA |
| 17 | P00172885 | OTHER | | MEDICARE RAILROAD |
| 18 | 258780808 | OTHER | | TRICARE PRIME REGION 3 |
| 19 | 60036873 | OTHER | | BCBS AL |
| 20 | 535026 | OTHER | | BCBS PPO |
