Provider Demographics
NPI:1033145826
Name:FLOYD, JAMIE V (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:V
Last Name:FLOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13326 N BLVD
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-1514
Mailing Address - Country:US
Mailing Address - Phone:269-649-9136
Mailing Address - Fax:
Practice Address - Street 1:13326 N BLVD
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097-1514
Practice Address - Country:US
Practice Address - Phone:269-649-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI076760207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4769898Medicaid
MIJF076760OtherBC/BS
MI4768353Medicaid
MI4768353Medicaid
MIM60660308Medicare ID - Type Unspecified