Provider Demographics
NPI:1750316444
Name:FLOYD, RICHARD D IV (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:FLOYD
Suffix:IV
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 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7818
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:1451 HARRODSBURG RD
Practice Address - Street 2:SUITE D 302
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3758
Practice Address - Country:US
Practice Address - Phone:859-977-0898
Practice Address - Fax:859-260-1278
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26079208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37903705OtherMEDICAID GROUP LAB
KY020015921OtherRR MEDICARE PIN
KY64260797Medicaid
KYASC1019OtherASC MEDICARE GROUP
KY36000818OtherASC MEDICAID GROUP
KYCB5773OtherRR MEDICARE GROUP
KY4000501OtherMEDICARE LAB
KY4000501OtherMEDICARE LAB
KYC66168Medicare UPIN