Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 100167 | FL |
NPI | 1003912635 |
---|---|
Provider Name | Dr. Jeremie Joseph Young |
First Address | Gainesville, FL 32608-7181 |
Second Address | Williston, FL 32696 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 14/05/2008 |