Provider Demographics
NPI:1417272469
Name:OUM, PHALYKA (MD)
Entity Type:Individual
Prefix:DR
First Name:PHALYKA
Middle Name:
Last Name:OUM
Suffix:
Gender:F
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:PO BOX 357730
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7730
Mailing Address - Country:US
Mailing Address - Phone:352-371-7546
Mailing Address - Fax:
Practice Address - Street 1:3700 NW 83RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5603
Practice Address - Country:US
Practice Address - Phone:352-371-7546
Practice Address - Fax:352-335-7546
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL115694207N00000X
FLME115694208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009664500Medicaid
FL009664500Medicaid