Provider Demographics
NPI:1891805057
Name:YUNGMANN, MARTIN PAUL (DO)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:PAUL
Last Name:YUNGMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:2893 ENTERPRISE RD STE 100
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2784
Practice Address - Country:US
Practice Address - Phone:386-789-8600
Practice Address - Fax:386-789-0219
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6376207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF9335Medicare UPIN
FL80755Medicare ID - Type Unspecified