Healthcare Provider Details

I. General information

NPI: 1912982000
Provider Name (Legal Business Name): JEFFREY THOMAS YOUNGKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E 32ND ST
AUSTIN TX
78705-2537
US

IV. Provider business mailing address

805 E 32ND ST
AUSTIN TX
78705-2537
US

V. Phone/Fax

Practice location:
  • Phone: 512-478-3188
  • Fax: 512-478-5092
Mailing address:
  • Phone: 512-478-3188
  • Fax: 512-478-5092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberF2133
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: