MEDICARE: DR. MARVIN JASON YOUNG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	ME80601	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	PTAN# DO3210	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ME80601	OTHER	FL	STATE LICENSE #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235221219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARVIN JASON YOUNG MD

Provider Business Mailing Address
First Line	:	1071 S SUN DR
Second Line	:	SUITE 1003
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2405
Country	:	US
Telephone Number	:	407-302-2620
Fax Number	:	407-302-2690

Provider Business Practice Location Address
First Line	:	1071 S SUN DR
Second Line	:	SUITE 1003
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2405
Country	:	US
Telephone Number	:	407-302-2620
Fax Number	:	407-302-2690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. MARVIN JASON YOUNG MD” Practice Location

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