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 | 207Q00000X | Family Medicine | | 00018045 | ALABAMA | 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 | 051099106 | OTHER | ALABAMA | BLUE SHIELD |
2 | G02076 | MEDICARE UPIN | ALABAMA | |
3 | 303769301 | MEDICAID | ALABAMA | |
4 | 303749301 | MEDICAID | ALABAMA | |
5 | D074 | OTHER | ALABAMA | MEDICARE GROUP NUMBER |
6 | G592 | OTHER | ALABAMA | MEDICARE GROUP NUMBER |
7 | 051099101 | OTHER | ALABAMA | BLUE SHIELD |
8 | 000055328 | MEDICARE ID-TYPE UNSPECIFIED | ALABAMA | |
9 | 303729301 | MEDICAID | ALABAMA | |
10 | 303709301 | MEDICAID | ALABAMA | |
11 | 303739301 | MEDICAID | ALABAMA | |
12 | 051055328 | OTHER | ALABAMA | BLUE SHIELD |
13 | 051099102 | OTHER | ALABAMA | BLUE SHIELD |
14 | 051099105 | OTHER | ALABAMA | BLUE SHIELD |
15 | 303799301 | MEDICAID | ALABAMA | |
16 | G591 | OTHER | ALABAMA | MEDICARE GROUP NUMBER |
17 | G590 | OTHER | ALABAMA | MEDICARE GROUP NUMBER |
18 | 510I080269 | MEDICARE PIN | ALABAMA | |
19 | G588 | OTHER | ALABAMA | MEDICARE GROUP NUMBER |
20 | G587 | OTHER | ALABAMA | MEDICARE GROUP NUMBER |
21 | 303719301 | MEDICAID | ALABAMA | |
22 | 051028060 | OTHER | ALABAMA | BLUE SHIELD |
23 | 051099104 | OTHER | ALABAMA | BLUE SHIELD |
24 | G586 | OTHER | ALABAMA | MEDICARE GROUP NUMBER |
25 | 000028060 | MEDICARE ID-TYPE UNSPECIFIED | ALABAMA | |