Provider Demographics
NPI:1912982000
Name:YOUNGKIN, JEFFREY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:YOUNGKIN
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 1:805 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2537
Mailing Address - Country:US
Mailing Address - Phone:512-478-3188
Mailing Address - Fax:512-478-5092
Practice Address - Street 1:805 E 32ND ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2537
Practice Address - Country:US
Practice Address - Phone:512-478-3188
Practice Address - Fax:512-478-5092
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2133207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB27746Medicare UPIN
TX00SG14Medicare ID - Type Unspecified