Provider Demographics
NPI:1215665997
Name:GORMAN, FLOYD JAMES
Entity type:Individual
Prefix:
First Name:FLOYD
Middle Name:JAMES
Last Name:GORMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10873 COLOMA RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2615
Mailing Address - Country:US
Mailing Address - Phone:916-365-5778
Mailing Address - Fax:
Practice Address - Street 1:10873 COLOMA RD UNIT 1
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2615
Practice Address - Country:US
Practice Address - Phone:916-365-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program