Provider Demographics
NPI:1043608623
Name:FLOYD, BRENDA (DO)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:FLOYD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114-5642
Mailing Address - Country:US
Mailing Address - Phone:601-847-0350
Mailing Address - Fax:
Practice Address - Street 1:278 GOOD HOPE RD
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-5642
Practice Address - Country:US
Practice Address - Phone:601-847-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine