Provider Demographics
NPI:1760432058
Name:OYAMA, OLIVER N (PHD, PA-C)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:N
Last Name:OYAMA
Suffix:
Gender:M
Credentials:PHD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 N MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-4254
Mailing Address - Country:US
Mailing Address - Phone:727-467-2400
Mailing Address - Fax:727-467-2477
Practice Address - Street 1:807 N MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755
Practice Address - Country:US
Practice Address - Phone:727-467-2400
Practice Address - Fax:727-467-2477
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101790363A00000X
FLPY0006467103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291151500Medicaid
FL970022638OtherRAILROAD MEDICARE NUMBER
FLE6443WMedicare PIN
FL970022638OtherRAILROAD MEDICARE NUMBER