Healthcare Provider Details

I. General information

NPI: 1558335943
Provider Name (Legal Business Name): THOMAS K YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 918025
ORLANDO FL
32891-8025
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-9449
  • Fax: 352-392-7488
Mailing address:
  • Phone: 352-392-9449
  • Fax: 352-392-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME25956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: