Provider Demographics
NPI:1669660965
Name:LLOYD, MARTHA REGINA
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:REGINA
Last Name:LLOYD
Suffix:
Gender:F
Credentials:
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 188
Mailing Address - Street 2:675 EAST MAIN STREET
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054
Mailing Address - Country:US
Mailing Address - Phone:386-496-1328
Mailing Address - Fax:386-496-2227
Practice Address - Street 1:675 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-1352
Practice Address - Country:US
Practice Address - Phone:386-496-1328
Practice Address - Fax:386-496-2227
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080185320OtherMEDICARE RAILROAD
FL23020Medicare PIN