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 | 101YM0800X | Counselor | Mental Health | | | No |
| 2 | 103T00000X | Psychologist | | | | No |
| 3 | 104100000X | Social Worker | | | | No |
| 4 | 207Q00000X | Family Medicine | | | | No |
| 5 | 207QA0401X | Family Medicine | Addiction Medicine | | | No |
| 6 | 207V00000X | Obstetrics & Gynecology | | | | No |
| 7 | 208000000X | Pediatrics | | | | No |
| 8 | 208100000X | Physical Medicine & Rehabilitation | | | | No |
| 9 | 2083X0100X | Preventive Medicine | Occupational Medicine | | | No |
| 10 | 2084A0401X | Psychiatry & Neurology | Addiction Medicine | | | No |
| 11 | 208600000X | Surgery | | | | No |
| 12 | 2086S0129X | Surgery | Vascular Surgery | | | No |
| 13 | 208C00000X | Colon & Rectal Surgery | | | | No |
| 14 | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | | | | No |
| 15 | 208D00000X | General Practice | | | | Yes |
