Provider Demographics
NPI:1134140775
Name:YOUNG, JOHN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
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 1:7241 BRYAN DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1538
Mailing Address - Country:US
Mailing Address - Phone:727-545-4600
Mailing Address - Fax:727-545-4611
Practice Address - Street 1:7241 BRYAN DAIRY RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1538
Practice Address - Country:US
Practice Address - Phone:727-545-4600
Practice Address - Fax:727-545-4611
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067443207QA0505X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26698YOtherMEDICARE ID
FLF13412Medicare UPIN