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 | | 21758 | NORTH CAROLINA | No |
| 2 | 207Q00000X | Family Medicine | | 19375 | NORTH CAROLINA | No |
| 3 | 207RP1001X | Internal Medicine | Pulmonary Disease | 2006-01195 | NORTH CAROLINA | No |
| 4 | 207X00000X | Orthopaedic Surgery | | 9901487 | NORTH CAROLINA | No |
| 5 | 208600000X | Surgery | | 2006-01711 | NORTH CAROLINA | No |
| 6 | 2086S0129X | Surgery | Vascular Surgery | 9501173 | NORTH CAROLINA | No |
| 7 | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | | 200001476 | NORTH CAROLINA | No |
| 8 | 363LA2200X | Nurse Practitioner | Adult Health | 900378 | NORTH CAROLINA | No |
| 9 | 363LA2200X | Nurse Practitioner | Adult Health | 104318 | NORTH CAROLINA | No |
| 10 | 367500000X | Nurse Anesthetist, Certified Registered | | 39775 | NORTH CAROLINA | No |
| 11 | 367500000X | Nurse Anesthetist, Certified Registered | | 186647 | NORTH CAROLINA | No |
| 12 | 367500000X | Nurse Anesthetist, Certified Registered | | 172850 | NORTH CAROLINA | No |
| 13 | 207R00000X | Internal Medicine | | 32811 | NORTH CAROLINA | 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 | 5905687 | MEDICAID | NORTH CAROLINA | |
| 2 | 8000361 | MEDICAID | NORTH CAROLINA | |
| 3 | 5900489 | MEDICAID | NORTH CAROLINA | |
| 4 | NPB196 | MEDICAID | SOUTH CAROLINA | |
| 5 | 2349196 | MEDICARE OSCAR/CERTIFICATION | NORTH CAROLINA | |
| 6 | NPB193 | MEDICAID | SOUTH CAROLINA | |
| 7 | NPB126 | MEDICAID | SOUTH CAROLINA | |
| 8 | NPB127 | MEDICAID | SOUTH CAROLINA | |
| 9 | 014R7 | OTHER | NORTH CAROLINA | BCBS GROUP |
| 10 | NPB125 | MEDICAID | SOUTH CAROLINA | |
| 11 | 5905483 | MEDICAID | NORTH CAROLINA | |
| 12 | 89014R7 | MEDICAID | NORTH CAROLINA | |
| 13 | NPB062 | MEDICAID | SOUTH CAROLINA | |
| 14 | DE0108 | OTHER | | RAILROAD MEDICARE GROUP |
| 15 | 5904930 | MEDICAID | NORTH CAROLINA | |
| 16 | NPB210 | MEDICAID | SOUTH CAROLINA | |
| 17 | 5900571 | MEDICAID | NORTH CAROLINA | |