Provider Demographics
NPI:1720037005
Name:JOE, BOBBY YOUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:YOUNG
Last Name:JOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BOBBY
Other - Middle Name:YOUNG
Other - Last Name:JOE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7630 PROUD LAND DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-9140
Mailing Address - Country:US
Mailing Address - Phone:901-754-2988
Mailing Address - Fax:
Practice Address - Street 1:13615 OLD HIGHWAY 61 NORTH
Practice Address - Street 2:HARRAH'S TAKE CARE HEALTH AND WELLNESS CLINIC
Practice Address - City:ROBINSONVILLE
Practice Address - State:MS
Practice Address - Zip Code:38664
Practice Address - Country:US
Practice Address - Phone:662-357-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13992207P00000X
MS9626208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA97081Medicare UPIN