Provider Demographics
NPI:1902994007
Name:FLOYD, HILLIARD DEREK (MD)
Entity Type:Individual
Prefix:
First Name:HILLIARD
Middle Name:DEREK
Last Name:FLOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 MCCULLOUGH AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5604
Mailing Address - Country:US
Mailing Address - Phone:210-224-8811
Mailing Address - Fax:
Practice Address - Street 1:1303 MCCULLOUGH AVE STE 225
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5604
Practice Address - Country:US
Practice Address - Phone:210-224-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3959208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033678601Medicaid
TXC15630Medicare UPIN
TX033678601Medicaid