Healthcare Provider Details

I. General information

NPI: 1114954138
Provider Name (Legal Business Name): CHARLES HENRY FLOYD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 NEWPORT PL
FORT SMITH AR
72903-5665
US

IV. Provider business mailing address

3304 NEWPORT PL
FORT SMITH AR
72903-5665
US

V. Phone/Fax

Practice location:
  • Phone: 479-651-4543
  • Fax:
Mailing address:
  • Phone: 479-651-4543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC2556
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: