Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | ME0046002 | FL |
NPI | 1073500856 |
---|---|
Provider Name | Dr. Mark P Young |
First Address | Miami, FL 33173-3570 |
Second Address | Miami, FL 33173-3570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 12/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056261100 | (05) | FL |
E21397 | (02) | FL |