Provider Demographics
NPI:1851686554
Name:YAM, PHILIP M (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:M
Last Name:YAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 FORT WADE RD UNIT 260
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5159
Mailing Address - Country:US
Mailing Address - Phone:904-659-8697
Mailing Address - Fax:
Practice Address - Street 1:203 FORT WADE RD UNIT 260
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32081-5159
Practice Address - Country:US
Practice Address - Phone:904-659-8697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA3004382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry