Provider Demographics
NPI:1902432008
Name:OUM, JASON S (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:OUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:9090 REGENCY SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-8119
Practice Address - Country:US
Practice Address - Phone:904-724-5576
Practice Address - Fax:904-390-7508
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2023-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME162379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine