Provider Demographics
NPI:1528190238
Name:YOUNG, JERALD MARTIN (CRNA)
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:MARTIN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:CRNA
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 791
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416
Mailing Address - Country:US
Mailing Address - Phone:970-856-6519
Mailing Address - Fax:970-856-6546
Practice Address - Street 1:1501 EAST 3RD STREET
Practice Address - Street 2:DELTA COUNTY MEMORIAL HOSPITAL
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416
Practice Address - Country:US
Practice Address - Phone:970-874-7681
Practice Address - Fax:970-874-2227
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO75028367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO412036143001OtherHMO
CO04017554Medicaid
CO412036143001OtherHMO