Provider Demographics
NPI:1629164678
Name:FLOYD, JUSTIN D (DO)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:D
Last Name:FLOYD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210W MCKINLEY AVE 1
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-5858
Mailing Address - Country:US
Mailing Address - Phone:217-877-9442
Mailing Address - Fax:217-876-6606
Practice Address - Street 1:321 REGENCY PARK STE 100
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1887
Practice Address - Country:US
Practice Address - Phone:618-416-7970
Practice Address - Fax:618-416-7971
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2001014924207RX0202X
IL036112641207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112641Medicaid
0970490001Medicare NSC
ILH49143Medicare UPIN
H49143Medicare UPIN
K14640Medicare PIN