Provider Demographics
NPI:1306840772
Name:YOUNG, EDWARD D (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:D
Last Name:YOUNG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1325 SAN MARCO BLVD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8568
Mailing Address - Country:US
Mailing Address - Phone:904-346-3465
Mailing Address - Fax:904-241-7331
Practice Address - Street 1:1577 ROBERTS DR
Practice Address - Street 2:SUITE 225
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3264
Practice Address - Country:US
Practice Address - Phone:904-241-1204
Practice Address - Fax:904-241-7331
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2020-11-16
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Provider Licenses
StateLicense IDTaxonomies
FLME57493207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3704157-00Medicaid
FL3704157-00Medicaid
FLF29115Medicare UPIN