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 | 208600000X | Surgery | | | | No |
| 2 | 2086S0122X | Surgery | Plastic and Reconstructive Surgery | | | No |
| 3 | 335E00000X | Prosthetic/Orthotic Supplier | | | | No |
| 4 | 2086S0129X | Surgery | Vascular Surgery | | | No |
| 5 | 207RX0202X | Internal Medicine | Medical Oncology | | | No |
| 6 | 213ES0103X | Podiatrist | Foot & Ankle Surgery | | | No |
| 7 | 224P00000X | Prosthetist | | | | No |
| 8 | 332B00000X | Durable Medical Equipment & Medical Supplies | | | | No |
| 9 | 207RH0000X | Internal Medicine | Hematology | | | No |
| 10 | 103TC0700X | Psychologist | Clinical | | | No |
| 11 | 207VX0201X | Obstetrics & Gynecology | Gynecologic Oncology | | | No |
| 12 | 2086X0206X | Surgery | Surgical Oncology | | | No |
| 13 | 207QH0002X | Family Medicine | Hospice and Palliative Medicine | | | No |
| 14 | 2085R0202X | Radiology | Diagnostic Radiology | | | No |
| 15 | 207RH0003X | Internal Medicine | Hematology & Oncology | | | 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 | 3709319 | MEDICAID | TENNESSEE | |
