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 | 207RN0300X | Internal Medicine | Nephrology | OS8229 | 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 | 0323474 | OTHER | FLORIDA | CIGNA |
| 2 | 2148967000 | OTHER | PENNSYLVANIA | INDEPENDENCE BC PA |
| 3 | K7092A | MEDICARE UPIN | FLORIDA | |
| 4 | KKA150339 | OTHER | | BCBS EXCELLUS NY |
| 5 | 0000ZCY746 | OTHER | MASSACHUSETTS | BCBS MASS |
| 6 | 2985402 | OTHER | FLORIDA | AETNA BLUE BELL |
| 7 | 471501 | OTHER | | TUFTS |
| 8 | 001457915 | OTHER | | BCBS HIGHMARK |
| 9 | 265580200 | MEDICAID | FLORIDA | |
| 10 | 30030181 | OTHER | FLORIDA | KEYSTONE MERCY HEALTH |
| 11 | =========T | OTHER | ILLINOIS | BCBS IL |
| 12 | 24133 | OTHER | FLORIDA | BCBS FL GRP NUMBER |
| 13 | 9814293 | OTHER | FLORIDA | AETNA |
| 14 | 7405063 | OTHER | | MAMSI INS |
| 15 | H36858 | MEDICARE UPIN | FLORIDA | |
| 16 | N279248 | MEDICAID | FLORIDA | |
| 17 | 2142967000 | OTHER | FLORIDA | AMERIHEALTH |
| 18 | K7092 | MEDICARE ID-TYPE UNSPECIFIED | FLORIDA | MEDICARE GROUP NUMBER |
| 19 | DC7655 | MEDICARE PIN | FLORIDA | |
| 20 | E5536 | MEDICARE ID-TYPE UNSPECIFIED | FLORIDA | OLD MEDICARE PROVIDER # |
| 21 | 651256 | OTHER | FLORIDA | COMBINED INS |
