Provider Demographics
NPI:1801110960
Name:JAMES W. YOUNG III MD PA
Entity type:Organization
Organization Name:JAMES W. YOUNG III MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:352-357-6786
Mailing Address - Street 1:801 NORTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-2945
Mailing Address - Country:US
Mailing Address - Phone:352-357-6786
Mailing Address - Fax:352-357-6386
Practice Address - Street 1:801 NORTHSHORE DR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-2945
Practice Address - Country:US
Practice Address - Phone:352-357-6786
Practice Address - Fax:352-357-6386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDM491AMedicare PIN