Provider Demographics
NPI:1679595755
Name:OSTROM, FLOYD II (DO)
Entity type:Individual
Prefix:
First Name:FLOYD
Middle Name:
Last Name:OSTROM
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W LANCASTER
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-3484
Mailing Address - Country:US
Mailing Address - Phone:817-390-2900
Mailing Address - Fax:817-390-2981
Practice Address - Street 1:1300 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3410
Practice Address - Country:US
Practice Address - Phone:817-336-8611
Practice Address - Fax:817-390-2981
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5595208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548230923OtherGROUP NPI NUMBER
TX133077110Medicaid
TX133077110Medicaid