Provider Demographics
NPI:1811003593
Name:YOUNG, SAMUEL DOAK III (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:DOAK
Last Name:YOUNG
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:D
Other - Last Name:YOUNG
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2080 CHILD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32214-5005
Mailing Address - Country:US
Mailing Address - Phone:904-542-7679
Mailing Address - Fax:
Practice Address - Street 1:2080 CHILD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-5005
Practice Address - Country:US
Practice Address - Phone:904-542-7679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96716207X00000X, 207XX0005X
VA0101240022207X00000X
NC2005-00921207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2762374-00Medicaid
FL813042151AMedicaid
SCNC1999Medicaid
NC1811003593Medicaid
SCNC1999Medicaid
L70259Medicare UPIN
FLAB550ZMedicare PIN