Provider Demographics
NPI:1790773521
Name:FLOYD, REBECCA R (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:FLOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5830
Mailing Address - Country:US
Mailing Address - Phone:479-474-5061
Mailing Address - Fax:479-922-2007
Practice Address - Street 1:620 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5830
Practice Address - Country:US
Practice Address - Phone:479-474-5061
Practice Address - Fax:479-922-2007
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100031750AMedicaid
AR118429001Medicaid
ARC68463Medicare UPIN
AR52259Medicare ID - Type Unspecified