Healthcare Provider Details

I. General information

NPI: 1982230389
Provider Name (Legal Business Name): WILLIAM HARRISON YOUNG MEDICAL STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD STOP 7200
DALLAS TX
75390-7200
US

IV. Provider business mailing address

108 SADDLE BROOK DR
HUDSON OAKS TX
76087-7017
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-0860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: