Healthcare Provider Details

I. General information

NPI: 1851690416
Provider Name (Legal Business Name): JASON RAYMOND YOUNGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 09/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 W 2ND PL
LAKEWOOD CO
80228-1527
US

IV. Provider business mailing address

707 ILLINOIS ST
GOLDEN CO
80401-1040
US

V. Phone/Fax

Practice location:
  • Phone: 303-921-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberDR.0058172
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0058172
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: