Provider Demographics
NPI:1376649202
Name:YOUNG, WILLIAM BRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRENT
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 1:1550 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4555
Mailing Address - Country:US
Mailing Address - Phone:352-683-6947
Mailing Address - Fax:352-686-7335
Practice Address - Street 1:1550 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4555
Practice Address - Country:US
Practice Address - Phone:352-683-6947
Practice Address - Fax:352-686-7335
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04767OtherUNIVERSAL HEALTHCARE
NY6000173OtherGHI
FL035267500Medicaid
FL020008163OtherMEDICARE RR
FL51203Medicare PIN
FL51203AMedicare PIN
FL020008163OtherMEDICARE RR