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General NPI Number Information
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NPI Number | 1194905141
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Entity Type | Organization
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Legal Business Name | YOUNG KIDS PEDIATRICS PA
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 6210 JOHN RYAN DR SUITE 109
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City | FORT WORTH
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State | TX
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Zip | 76132-4113
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Country | US
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Telephone | 817-361-7494
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Fax |
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Provider Business Mailing Address
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Address Line | 6210 JOHN RYAN DR SUITE 109
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City | FORT WORTH
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State | TX
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Zip | 76132-4113
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN GABBERT YOUNG
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Credential | M.D.
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Telephone | 817-361-7494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | G8527
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License Number State | TX
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