Provider Demographics
NPI:1669462925
Name:YOUNG, JAMES W III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:YOUNG
Suffix:III
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 1:996 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-3740
Mailing Address - Country:US
Mailing Address - Phone:352-729-2399
Mailing Address - Fax:
Practice Address - Street 1:996 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-3740
Practice Address - Country:US
Practice Address - Phone:352-729-2399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40695208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053441200Medicaid
FLD85631Medicare UPIN
FL35191YMedicare PIN