Provider Demographics
NPI:1275069478
Name:YOUNG, JEFFREY JOE
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JOE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 TIMBER DR.
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-5152
Mailing Address - Country:US
Mailing Address - Phone:972-308-7450
Mailing Address - Fax:
Practice Address - Street 1:2129 GREEN LEE LANE
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-5152
Practice Address - Country:US
Practice Address - Phone:972-308-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization