Provider Demographics
NPI:1720072333
Name:YOUNG, JEFFREY MILTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MILTON
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 SENTIERO DELLA VILLA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-4502
Mailing Address - Country:US
Mailing Address - Phone:505-920-0488
Mailing Address - Fax:858-832-8163
Practice Address - Street 1:360 S LOLA LN
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-0884
Practice Address - Country:US
Practice Address - Phone:775-751-7561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34567207P00000X
NV6126207P00000X
NMMD2006-0062207P00000X
HIMD13719207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME63850Medicare UPIN
NVBE298ZMedicare PIN