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 | 207VG0400X | Obstetrics & Gynecology | Gynecology | 22397 | SOUTH DAKOTA | No |
| 2 | 207VX0000X | Obstetrics & Gynecology | Obstetrics | 22397 | SOUTH DAKOTA | No |
| 3 | 207VM0101X | Obstetrics & Gynecology | Maternal & Fetal Medicine | BOARD ELIGIBLE | SOUTH DAKOTA | 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 | 17089 | OTHER | ARIZONA | ALLOPATHIC LICENSE AZ |
| 2 | 860843193N3 | OTHER | ARIZONA | PACIFIC CARE |
| 3 | 201257 | OTHER | CALIFORNIA | ALLOPATHIC LICENSE CA |
| 4 | D77206 | MEDICARE UPIN | ARIZONA | |
| 5 | Z0836 | MEDICAID | UTAH | |
| 6 | 1Z9856 | OTHER | ARIZONA | HEALTH NET |
| 7 | 3580150.02 | OTHER | ARIZONA | CIGNA PPO |
| 8 | 269432 | MEDICAID | ARIZONA | |
| 9 | XPY075910 | MEDICAID | CALIFORNIA | |
| 10 | 7959 | OTHER | | CANADIAN MD LICENSE |
| 11 | 2007300 | OTHER | ARIZONA | CIGNA HMO |
| 12 | 4735 | OTHER | ARIZONA | ATENA |
| 13 | AZ0802940 | OTHER | ARIZONA | BLUE CROSS BLUE SHIELD |
| 14 | MD17089 | MEDICARE ID-TYPE UNSPECIFIED | ARIZONA | MEDICARE |
