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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | ME67898 | 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 | 24911 | OTHER | FLORIDA | HEALTHEASE MCD PROV ID # |
| 2 | 13461 | OTHER | FLORIDA | FHHS PROV ID # |
| 3 | 1729689 | OTHER | FLORIDA | UNITED H'CARE PROV ID # |
| 4 | 1882089017 | OTHER | FLORIDA | CIGNA PROV ID # |
| 5 | 201815 | OTHER | FLORIDA | AMERIGROUP MCD PROV ID # |
| 6 | 24911 | OTHER | FLORIDA | WELLCARE PROV ID # |
| 7 | 872616 | OTHER | FLORIDA | FIRST HEALTH PROV ID # |
| 8 | 5842303 | OTHER | FLORIDA | AETNA PROVIDER ID |
| 9 | 27172 | OTHER | FLORIDA | BCBS OF FL PROV ID # |
| 10 | 378344800 | MEDICAID | FLORIDA | |
| 11 | 598010 | OTHER | FLORIDA | HUMANA/CHOICECARE PROV ID |
| 12 | 060068680 | OTHER | FLORIDA | RAILROAD MEDICARE |
| 13 | 24911 | OTHER | FLORIDA | STAYWELL MCD PROV ID # |
| 14 | 175483 | OTHER | FLORIDA | GREAT WEST PROV ID # |