MEDICARE: DR. BOBBY YOUNG JOE M.D.

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	207P00000X	Emergency Medicine Physician	13992	TN
2	208D00000X	General Practice Physician	9626	MS

General Provider Information

NPI Number	:	1720037005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOBBY YOUNG JOE M.D.

Provider Business Mailing Address
First Line	:	7630 PROUD LAND DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-9140
Country	:	US
Telephone Number	:	901-754-2988
Fax Number	:

Provider Business Practice Location Address
First Line	:	13615 OLD HIGHWAY 61 NORTH
Second Line	:	HARRAH'S TAKE CARE HEALTH AND WELLNESS CLINIC
City	:	ROBINSONVILLE
State	:	MS
Zip	:	38664
Country	:	US
Telephone Number	:	662-357-3264
Fax Number	:

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	04/07/2009

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