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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | ME60109 | FLORIDA | No |
| 2 | 207UN0901X | Nuclear Medicine | Nuclear Cardiology | ME60109 | FLORIDA | No |
| 3 | 207RI0011X | Internal Medicine | Interventional Cardiology | ME60109 | 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 | 975093 | OTHER | FLORIDA | UNITED H'CARE PROV ID # |
| 2 | 597544 | OTHER | FLORIDA | HUMANA PROV ID # |
| 3 | F12511 | MEDICARE UPIN | | |
| 4 | 03088 | OTHER | FLORIDA | STAYWELL MCD PROV ID # |
| 5 | 11589 | OTHER | FLORIDA | FHHS PROV ID # |
| 6 | 207947 | OTHER | FLORIDA | AMERIGROUP MCD PROV ID # |
| 7 | 15074 | OTHER | FLORIDA | BCBS OF FL PROV ID # |
| 8 | 4302087 | OTHER | FLORIDA | AETNA PROV ID # |
| 9 | 15074Z | MEDICARE PIN | FLORIDA | |
| 10 | 371044100 | MEDICAID | FLORIDA | |
| 11 | 043204 | OTHER | FLORIDA | GREAT WEST PROV ID # |
| 12 | 6328420015 | OTHER | FLORIDA | CIGNA PROV ID # |
| 13 | 03088 | OTHER | FLORIDA | HEALTHEASE MCD PROV ID # |
| 14 | 672144 | OTHER | FLORIDA | FIRST HEALTH PROV ID # |
| 15 | 03088 | OTHER | FLORIDA | WELLCARE PROV ID # |
| 16 | 110059670 | OTHER | FLORIDA | RAILROAD MEDICARE |