Healthcare Provider Details

I. General information

NPI: 1134140775
Provider Name (Legal Business Name): JOHN DAVID YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7241 BRYAN DAIRY RD
LARGO FL
33777-1538
US

IV. Provider business mailing address

7241 BRYAN DAIRY RD
LARGO FL
33777-1538
US

V. Phone/Fax

Practice location:
  • Phone: 727-545-4600
  • Fax: 727-545-4611
Mailing address:
  • Phone: 727-545-4600
  • Fax: 727-545-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME0067443
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME0067443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: