Provider Demographics
NPI:1689663403
Name:HENNAN, FLOYD ARTHUR (DO)
Entity Type:Individual
Prefix:
First Name:FLOYD
Middle Name:ARTHUR
Last Name:HENNAN
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 1:200 E LIVINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN AUGUSTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75972-2028
Mailing Address - Country:US
Mailing Address - Phone:936-275-9910
Mailing Address - Fax:936-275-9710
Practice Address - Street 1:200 E LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:SAN AUGUSTINE
Practice Address - State:TX
Practice Address - Zip Code:75972-2028
Practice Address - Country:US
Practice Address - Phone:936-275-9910
Practice Address - Fax:936-275-9710
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036724504Medicaid
TX036724502Medicaid
TX036724506Medicaid
TXF50217Medicare UPIN
TX036724504Medicaid
TX8B6062Medicare ID - Type Unspecified
TX036724506Medicaid
TX8B6062Medicare PIN