Provider Demographics
NPI:1689797029
Name:YOUNG, THOMAS P III (NP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:YOUNG
Suffix:III
Gender:M
Credentials:NP
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Mailing Address - Street 1:55 PIKES PEAK DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1121
Mailing Address - Country:US
Mailing Address - Phone:415-388-2360
Mailing Address - Fax:415-968-6620
Practice Address - Street 1:1615 HILL RD STE J
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4338
Practice Address - Country:US
Practice Address - Phone:415-895-1441
Practice Address - Fax:415-895-1288
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2020-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA349096363LA2200X
CA7662363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP72008Medicare UPIN