Provider Demographics
NPI:1093825523
Name:FLOYD, GARY W (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:W
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 1:1500 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4917
Mailing Address - Country:US
Mailing Address - Phone:817-927-1105
Mailing Address - Fax:
Practice Address - Street 1:1500 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4917
Practice Address - Country:US
Practice Address - Phone:817-927-1105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6079208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX048771202Medicaid
TX112835100OtherFIRSTCARE PIN
TX8B2071OtherBCBSTX IND PIN
TX9068647OtherCIGNA PIN
TX108129OtherUHC PIN
TX136098409Medicaid
TX163314101Medicaid
TX4586113OtherAETNA PIN
TX0003GSOtherBCBSTX GRP PIN
TX080626701Medicaid
TX10029073OtherAMERIGROUP PIN
TX1640327OtherFIRSTHEALTH PIN
TX136098408Medicaid
1669442042OtherGRP NPI NUMBER
TX170994101Medicaid
TX413455OtherPHCS PIN
TX080626701Medicaid