Provider Demographics
NPI:1457428021
Name:FLOYD, JON W (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:W
Last Name:FLOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2999 REGENT ST
Mailing Address - Street 2:#612
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2146
Mailing Address - Country:US
Mailing Address - Phone:510-848-1733
Mailing Address - Fax:510-848-8224
Practice Address - Street 1:2999 REGENT ST
Practice Address - Street 2:#612
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2146
Practice Address - Country:US
Practice Address - Phone:510-848-1733
Practice Address - Fax:510-848-8224
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG696872088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY49005YMedicaid
CAYYY49005YMedicaid
CAB74748Medicare UPIN