Provider Demographics
NPI:1326601576
Name:FLOOD, JOHN (RD, CD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FLOOD
Suffix:
Gender:M
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7637 E STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8565
Mailing Address - Country:US
Mailing Address - Phone:802-309-0753
Mailing Address - Fax:
Practice Address - Street 1:7637 E STONEGATE DR STE 4
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8565
Practice Address - Country:US
Practice Address - Phone:802-309-0753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002346A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered