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 | 207RG0100X | Internal Medicine | Gastroenterology | | | No |
| 2 | 207RP1001X | Internal Medicine | Pulmonary Disease | | | No |
| 3 | 207T00000X | Neurological Surgery | | | | No |
| 4 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 5 | 363A00000X | Physician Assistant | | | | No |
| 6 | 363AS0400X | Physician Assistant | Surgical | | | No |
| 7 | 363L00000X | Nurse Practitioner | | | | No |
| 8 | 363LA2200X | Nurse Practitioner | Adult Health | | | No |
| 9 | 363LF0000X | Nurse Practitioner | Family | | | No |
| 10 | 207R00000X | Internal Medicine | | | | Yes |