Healthcare Provider Details

I. General information

NPI: 1104909548
Provider Name (Legal Business Name): LAWRENCE LUEN SHEAN YEUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 01/13/2010

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0247
US

IV. Provider business mailing address

1600 SW ARCHER RD PO BOX 100247
GAINESVILLE FL
32610-0247
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6815
  • Fax:
Mailing address:
  • Phone: 352-273-6815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2010005865
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME106832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: