Provider Demographics
NPI:1447235536
Name:JEFFREY T. YOUNGKIN, M.D. ASSOCIATED
Entity Type:Organization
Organization Name:JEFFREY T. YOUNGKIN, M.D. ASSOCIATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:YOUNGKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-478-3188
Mailing Address - Street 1:805 E 32ND ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2537
Mailing Address - Country:US
Mailing Address - Phone:512-478-3188
Mailing Address - Fax:
Practice Address - Street 1:805 E 32ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2537
Practice Address - Country:US
Practice Address - Phone:512-478-3188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2133207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB27746Medicare UPIN