MEDICARE: PHILIP M YAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	300438	LA

General Provider Information

NPI Number	:	1851686554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP M YAM M.D.

Provider Business Mailing Address
First Line	:	203 FORT WADE RD UNIT 260
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32081-5159
Country	:	US
Telephone Number	:	904-659-8697
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 FORT WADE RD UNIT 260
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32081-5159
Country	:	US
Telephone Number	:	904-659-8697
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2011
Last Update Date	:	08/07/2023

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