Provider Demographics
NPI:1720304348
Name:YOUNG, HOMER LEE JR
Entity Type:Individual
Prefix:
First Name:HOMER
Middle Name:LEE
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10003 FORUM WEST DR APT 271
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8318
Mailing Address - Country:US
Mailing Address - Phone:832-256-4524
Mailing Address - Fax:
Practice Address - Street 1:10003 FORUM WEST DR APT 271
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8318
Practice Address - Country:US
Practice Address - Phone:832-256-4524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver