Healthcare Provider Details

I. General information

NPI: 1649290974
Provider Name (Legal Business Name): WALTER FLOYD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CAMBRIDGE DR
WETUMPKA AL
36093-1258
US

IV. Provider business mailing address

11 CAMBRIDGE DR
WETUMPKA AL
36093-1258
US

V. Phone/Fax

Practice location:
  • Phone: 334-567-8633
  • Fax: 334-567-9478
Mailing address:
  • Phone: 334-567-8633
  • Fax: 334-567-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11396
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: