Provider Demographics
NPI:1609840297
Name:KIM, LLOYD Y (MD)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:Y
Last Name:KIM
Suffix:
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 1:4500 W NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2245
Mailing Address - Country:US
Mailing Address - Phone:352-336-6000
Mailing Address - Fax:352-336-6029
Practice Address - Street 1:17270 SE 109TH TERRACE RD
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-9015
Practice Address - Country:US
Practice Address - Phone:352-633-7222
Practice Address - Fax:352-633-7205
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46968207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
07495OtherBCBS
FL251677200Medicaid
D61518Medicare UPIN
07495OtherBCBS
FL07495GMedicare PIN