Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME57406 | FL |
N | 207QA0505X | Family Doctor - Adult Medicine | 030930 | GA |
Y | 207QA0505X | Family Doctor - Adult Medicine | ME57406 | FL |
N | 208D00000X | General Practice Physician | ME57406 | FL |
NPI | 1245265677 |
---|---|
Provider Name | Dr. George Morrison Young JR. |
First Address | Jacksonville, FL 32246-6699 |
Second Address | Jacksonville, FL 32246-6699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 17/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009375000 | (05) | FL |
11906O | (02) | FL |
D-42276 | (02) | FL |