Provider Demographics
NPI:1962704304
Name:LLOYD CENTER MEDICAL CLINIC PC
Entity type:Organization
Organization Name:LLOYD CENTER MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-282-2502
Mailing Address - Street 1:2252 LLOYD CTR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1311
Mailing Address - Country:US
Mailing Address - Phone:503-282-2502
Mailing Address - Fax:503-249-0407
Practice Address - Street 1:2252 LLOYD CTR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1311
Practice Address - Country:US
Practice Address - Phone:503-282-2502
Practice Address - Fax:503-249-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD05881207Q00000X, 208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty