Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | ME0067443 | FL |
Y | 207QA0505X | Family Doctor - Adult Medicine | ME0067443 | FL |
NPI | 1134140775 |
---|---|
Provider Name | John David Young |
First Address | Largo, FL 33777-1538 |
Second Address | Largo, FL 33777-1538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26698Y | MEDICARE ID (01) | FL |
F13412 | (02) | FL |