Provider Demographics
NPI:1710191622
Name:FLOYD, JOHN DAVIDSON III (OTRL)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVIDSON
Last Name:FLOYD
Suffix:III
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W FRANCES AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-2005
Mailing Address - Country:US
Mailing Address - Phone:813-225-2040
Mailing Address - Fax:
Practice Address - Street 1:3901 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-5603
Practice Address - Country:US
Practice Address - Phone:727-526-5432
Practice Address - Fax:727-526-5432
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10233174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886748800Medicaid