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 | 213ES0103X | Podiatrist | Foot & Ankle Surgery | NM296 | NEW MEXICO | No |
2 | 213E00000X | Podiatrist | | NM296 | NEW MEXICO | 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 | NMB2387 | OTHER | NEW MEXICO | MCARE GROUP PIN |
2 | 1093042632 | OTHER | NEW MEXICO | GROUP NPI # FOR CORPORATION |
3 | DR8662 | OTHER | NEW MEXICO | RR MCARE GRP PIN |
4 | NM296 | OTHER | NEW MEXICO | MEDICAL LICENSE # |
5 | V00563 | MEDICARE UPIN | NEW MEXICO | |
6 | 01331752 | OTHER | NEW MEXICO | AMERIGROUP |
7 | 4781043 | OTHER | NEW MEXICO | CIGNA |
8 | 85207578 | OTHER | NEW MEXICO | MCAID GROUP |
9 | P00972986 | OTHER | NEW MEXICO | RR MCARE IND PIN |
10 | 6321870001 | MEDICARE NSC | NEW MEXICO | |
11 | 9558062 | OTHER | NEW MEXICO | AETNA |
12 | 22952039 | MEDICAID | NEW MEXICO | |
13 | NM400249 | MEDICARE PIN | | |