Provider Demographics
NPI:1972502953
Name:GONZALEZ, FLOYD (MD)
Entity Type:Individual
Prefix:
First Name:FLOYD
Middle Name:
Last Name:GONZALEZ
Suffix:
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 1:821 WALTER J LEEPER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-2591
Mailing Address - Country:US
Mailing Address - Phone:870-642-8640
Mailing Address - Fax:870-642-3516
Practice Address - Street 1:821 WALTER J LEEPER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2591
Practice Address - Country:US
Practice Address - Phone:870-642-8640
Practice Address - Fax:870-642-3516
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE16282080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100213340BOtherSOONERCARE
OK100213340AMedicaid
AR133554001Medicaid
ARG65915Medicare UPIN