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 | 207K00000X | Allergy & Immunology | | 104718 | MISSOURI | No |
| 2 | 207RR0500X | Internal Medicine | Rheumatology | 104718 | MISSOURI | 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 | 100157390A | MEDICAID | KANSAS | |
| 2 | 100182380 | MEDICAID | OKLAHOMA | |
| 3 | 10534 | OTHER | | COVENTRY HEALTH CARE OF K |
| 4 | 431659121 64804 A001 | OTHER | | TRICARE WEST |
| 5 | 0005751036 | OTHER | | AETNA |
| 6 | 604040 | MEDICAID | KANSAS | |
| 7 | 206909400 | MEDICAID | MISSOURI | |
| 8 | XXXXX8519 64804 0000 | OTHER | | TRICARE FOR LIFE |
| 9 | 8478 | OTHER | MISSOURI | BLUE CROSS |
| 10 | 431659121 0003 | OTHER | | CIGNA |