Healthcare Provider Details

I. General information

NPI: 1760467450
Provider Name (Legal Business Name): BONNIE L FLOYD MD FACC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN STE B 215
DALLAS TX
75230-2505
US

IV. Provider business mailing address

PO BOX 650044
DALLAS TX
75265-0044
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-2822
  • Fax: 972-566-8343
Mailing address:
  • Phone: 972-566-2822
  • Fax: 972-566-8343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG8596
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG8596
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG8596
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberG8596
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: