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 | 2085R0202X | Radiology | Diagnostic Radiology | | | No |
| 2 | 363AM0700X | Physician Assistant | Medical | | | No |
| 3 | 2086S0129X | Surgery | Vascular Surgery | | | No |
| 4 | 363L00000X | Nurse Practitioner | | | | No |
| 5 | 2085R0204X | Radiology | Vascular & Interventional Radiology | | | No |
| 6 | 2085U0001X | Radiology | Diagnostic Ultrasound | | | No |
| 7 | 2085B0100X | Radiology | Body Imaging | | | No |
| 8 | 2085R0203X | Radiology | Therapeutic Radiology | | | No |
| 9 | 2085N0700X | Radiology | Neuroradiology | | | No |
| 10 | 2085N0904X | Radiology | Nuclear Radiology | | | No |
| 11 | 2085P0229X | Radiology | Pediatric Radiology | | | No |
| 12 | 363AS0400X | Physician Assistant | Surgical | | | Yes |