Healthcare Provider Details

I. General information

NPI: 1487655973
Provider Name (Legal Business Name): JAMES W YOUNG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 W 8TH ST
YANKTON SD
57078-3306
US

IV. Provider business mailing address

1104 W 8TH ST
YANKTON SD
57078-3306
US

V. Phone/Fax

Practice location:
  • Phone: 605-665-7841
  • Fax: 605-665-0546
Mailing address:
  • Phone: 605-665-7841
  • Fax: 605-665-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4413
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: