Provider Demographics
NPI:1760467450
Name:FLOYD, BONNIE L (MD FACC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:FLOYD
Suffix:
Gender:F
Credentials:MD FACC
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 650044
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0044
Mailing Address - Country:US
Mailing Address - Phone:972-566-2822
Mailing Address - Fax:972-566-8343
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:STE B 215
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-2822
Practice Address - Fax:972-566-8343
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8596207R00000X, 207RI0011X, 207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136742711Medicaid
TX8R3680OtherBCBS
TX8R3680OtherBCBS
B22736Medicare UPIN
TX136742711Medicaid