Provider Demographics
NPI:1578110052
Name:YOUNG, JAMES A
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
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 62
Mailing Address - Street 2:
Mailing Address - City:FORT COBB
Mailing Address - State:OK
Mailing Address - Zip Code:73038-0062
Mailing Address - Country:US
Mailing Address - Phone:405-439-1589
Mailing Address - Fax:
Practice Address - Street 1:25053 COUNTRY STREET 2540
Practice Address - Street 2:
Practice Address - City:FORT COBB
Practice Address - State:OK
Practice Address - Zip Code:73038
Practice Address - Country:US
Practice Address - Phone:405-439-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist