Provider Demographics
NPI:1275523227
Name:BAYOUTH, OLIVER KENNETH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:KENNETH
Last Name:BAYOUTH
Suffix:JR
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 1:3431 S ORANGE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-8508
Mailing Address - Country:US
Mailing Address - Phone:407-425-4422
Mailing Address - Fax:407-425-4294
Practice Address - Street 1:3431 S ORANGE AVE STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-8508
Practice Address - Country:US
Practice Address - Phone:407-425-4422
Practice Address - Fax:407-425-4294
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045179207V00000X, 207VM0101X, 207VX0000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
04386Medicare ID - Type Unspecified
FLD84784Medicare UPIN