Provider Demographics
NPI:1043259161
Name:DILLARD, FLOYD S (MD)
Entity Type:Individual
Prefix:
First Name:FLOYD
Middle Name:S
Last Name:DILLARD
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 1:826 N BAY ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-2942
Mailing Address - Country:US
Mailing Address - Phone:352-357-6500
Mailing Address - Fax:352-357-9136
Practice Address - Street 1:826 N BAY ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-2942
Practice Address - Country:US
Practice Address - Phone:352-357-6500
Practice Address - Fax:352-357-9136
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 58103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11661OtherBCBS PROVIDER NUMBER
FLE67921Medicare UPIN
FL11661Medicare PIN