Provider Demographics
NPI:1861470809
Name:FLOYD, MICHAEL DWIGHT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DWIGHT
Last Name:FLOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:103 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4703
Mailing Address - Country:US
Mailing Address - Phone:865-273-1752
Mailing Address - Fax:865-273-1755
Practice Address - Street 1:907 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5015
Practice Address - Country:US
Practice Address - Phone:865-980-4897
Practice Address - Fax:865-977-4796
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN28642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3815872Medicaid
TNQ005400Medicaid
TNC60731Medicare UPIN
TNQ005400Medicaid