Basic Information
| Provider Information | |||||||||
| NPI: | 1518988682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLOYD | ||||||||
| FirstName: | ROBIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 497 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720060497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703472534 | ||||||||
| FaxNumber: | 8703471235 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | MAYFIELD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420662203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708047710 | ||||||||
| FaxNumber: | 2708047722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 03/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 29657 | KY | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 208D00000X | 29657 | KY | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 64296577 | 05 | KY | MEDICAID | 000000587301 | 01 | KY | ANTHEM BCBS | OTHER |