Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 076760 | MI |
NPI | 1033145826 |
---|---|
Provider Name | Dr. Jamie V Floyd |
First Address | Vicksburg, MI 49097-1514 |
Second Address | Vicksburg, MI 49097-1514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 05/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4768353 | (05) | MI |
4769898 | (05) | MI |
F90865 | (02) | MI |
JF076760 | BC/BS (01) | MI |