Provider Demographics
NPI:1306844964
Name:YOUNG, STEPHEN E (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32727-0490
Mailing Address - Country:US
Mailing Address - Phone:352-253-2511
Mailing Address - Fax:352-253-2522
Practice Address - Street 1:1707 MAYO DRIVE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778
Practice Address - Country:US
Practice Address - Phone:352-253-2511
Practice Address - Fax:352-253-2522
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272928800Medicaid
FL272928800Medicaid