Healthcare Provider Details

I. General information

NPI: 1659450369
Provider Name (Legal Business Name): HENRY BASCOM FLOYD IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 E SEMORAN BLVD
APOPKA FL
32703-5710
US

IV. Provider business mailing address

3158 TALA LOOP
LONGWOOD FL
32779-3127
US

V. Phone/Fax

Practice location:
  • Phone: 407-628-9100
  • Fax: 407-628-0748
Mailing address:
  • Phone: 407-805-8838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME50327
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: