Provider Demographics
NPI:1205072485
Name:YOUNG, JEFREY J (RPSGT,RCP)
Entity type:Individual
Prefix:
First Name:JEFREY
Middle Name:J
Last Name:YOUNG
Suffix:
Gender:M
Credentials:RPSGT,RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 W CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-3318
Mailing Address - Country:US
Mailing Address - Phone:580-237-8900
Mailing Address - Fax:580-237-8901
Practice Address - Street 1:1017 W CHERRY AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-3318
Practice Address - Country:US
Practice Address - Phone:580-237-8900
Practice Address - Fax:580-237-8901
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK989227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified