Provider Demographics
NPI:1003912635
Name:YOUNG, JEREMIE JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMIE
Middle Name:JOSEPH
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9118 SW 49TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7181
Mailing Address - Country:US
Mailing Address - Phone:352-226-8272
Mailing Address - Fax:
Practice Address - Street 1:125 SW 7TH STREET
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696
Practice Address - Country:US
Practice Address - Phone:352-528-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100167208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice