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 | | ME36891 | FLORIDA | 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 | 21333 | OTHER | FLORIDA | BLUE MEDICARE ADVANTAGE |
| 2 | 5309586 | OTHER | FLORIDA | AETNA GLOBAL BENEFITS |
| 3 | 59024373 | OTHER | ALABAMA | BLUE CROSS AND BLUE SHIELD OF ALABAMA |
| 4 | D56806 | MEDICARE UPIN | | |
| 5 | 1871546515 | OTHER | FLORIDA | PYRAMID CLAIMS |
| 6 | 57089 | OTHER | FLORIDA | PREFERRED PATIENT CARE |
| 7 | 660022102 | MEDICAID | FLORIDA | |
| 8 | 57089 | MEDICARE PIN | FLORIDA | |
| 9 | 593216460A06 | OTHER | FLORIDA | MEDICAL MUTUAL |
| 10 | 592014611B | OTHER | FLORIDA | HUMANA/EMPLOYERS HEALTH |
| 11 | 000800449 | OTHER | ALABAMA | ALACAID |
| 12 | 1050038 | OTHER | FLORIDA | CIGNA HEALTHCARE |
| 13 | 5309586 | OTHER | FLORIDA | AETNA |
| 14 | 592014611B | OTHER | FLORIDA | HUMANA CLAIMS OFFICE |
| 15 | 0166758 | OTHER | FLORIDA | DEFINITY HEALTH CLAIMS |
| 16 | A093 | OTHER | FLORIDA | HEALTH FIRST NETWORK |
| 17 | 5309586 | OTHER | FLORIDA | AETNA US HEALTHCARE |
| 18 | 039350900 | MEDICAID | FLORIDA | |
| 19 | 103858 | MEDICARE OSCAR/CERTIFICATION | FLORIDA | |
| 20 | 21333 | OTHER | | BLUE CROSS AND BLUE SHIELD OF FLORIDA |
| 21 | 0166758 | OTHER | FLORIDA | UNITED HEALTHCARE OF FLORIDA |
| 22 | N146 | OTHER | FLORIDA | WELLCARE |
| 23 | 051128 | OTHER | FLORIDA | VISTA |
| 24 | 21333 | OTHER | FLORIDA | ADVANTAGE 65 |
| 25 | 541009001 | OTHER | ALABAMA | ALACAID |
| 26 | 57089 | OTHER | FLORIDA | BLUE CROSS AND BLUE SHIELD OF FLORIDA |
| 27 | 57089 | OTHER | FLORIDA | HEALTH 1ST NETWORK, INC. |
| 28 | 59116861 | OTHER | ALABAMA | BLUE CROSS AND BLUE SHIELD OF ALABAMA |
| 29 | 0166758 | OTHER | FLORIDA | UNITED HEALTHCARE |
| 30 | P00017879 | OTHER | FLORIDA | RAILROAD MEDICARE |
| 31 | 1050038 | OTHER | FLORIDA | CIGNA INTERNATIONAL |
| 32 | 660022100 | MEDICAID | FLORIDA | |
