Healthcare Provider Details

I. General information

NPI: 1992979546
Provider Name (Legal Business Name): YOUNG FOUNDATIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7241 BRYAN DAIRY RD
LARGO FL
33777
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

VIII. Authorized Official

Name: DR. JOHN D YOUNG
Title or Position: OWNER
Credential: M.D.
Phone: 727-545-4600