Provider Demographics
NPI:1518958230
Name:YOUNG, JEROME CLAYTON (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:CLAYTON
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 1:508 MEDICAL CENTER BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2953
Mailing Address - Country:US
Mailing Address - Phone:936-760-4600
Mailing Address - Fax:936-760-4601
Practice Address - Street 1:508 MEDICAL CENTER BLVD
Practice Address - Street 2:STE 150
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2953
Practice Address - Country:US
Practice Address - Phone:936-760-4600
Practice Address - Fax:936-760-4601
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8848174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113255704Medicaid
10028127OtherAMERIGROUP ID NUMBER
TX8A5130OtherBLUE CROSS/BLUE SHIELD #
G65170Medicare UPIN
TX8F33710Medicare PIN