Healthcare Provider Details

I. General information

NPI: 1528190238
Provider Name (Legal Business Name): JERALD MARTIN YOUNG CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 EAST 3RD STREET DELTA COUNTY MEMORIAL HOSPITAL
DELTA CO
81416
US

IV. Provider business mailing address

PO BOX 791
DELTA CO
81416
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-7681
  • Fax: 970-874-2227
Mailing address:
  • Phone: 970-856-6519
  • Fax: 970-856-6546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number75028
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: