Provider Demographics
NPI:1659339943
Name:FLOYD, RANDALL C (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:C
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:500 KEENE ST
Practice Address - Street 2:SUITE 406
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8104
Practice Address - Country:US
Practice Address - Phone:573-499-6041
Practice Address - Fax:573-499-6091
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD108201207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO272468OtherHEALTHLINK
MO207983107Medicaid
MO5574OtherBLUE SHIELD/BLUE CHOICE
KS2086350201OtherKANSAS MEDICAID
MO7409028OtherUNITED HEALTHCARE
MO7409028OtherUNITED HEALTHCARE
G04785Medicare UPIN
MO969365236Medicare PIN
MO160029931Medicare PIN