Provider Demographics
NPI:1740214279
Name:YOUNG, JOSEPH JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JAMES
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8340
Mailing Address - Country:US
Mailing Address - Phone:580-353-5860
Mailing Address - Fax:580-353-0792
Practice Address - Street 1:4214 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8340
Practice Address - Country:US
Practice Address - Phone:580-353-5860
Practice Address - Fax:580-353-0792
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13033207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100093680AMedicaid
OK731221077OtherTAX ID
OK731221077OtherTAX ID
OKD42954Medicare UPIN