Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | M-5623 | ID |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | M-5623 | ID |
N | 207XS0117X | Orthopaedic Spine Surgeon | M-5623 | ID |
N | 207XX0801X | Orthopaedic Trauma Surgeon | M-5623 | ID |
NPI | 1124039714 |
---|---|
Provider Name | Dr. Charles T Floyd |
First Address | Meridian, ID 83642-1026 |
Second Address | Boise, ID 83706-1348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 12/06/2012 |