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General NPI Number Information
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NPI Number | 1194956599
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Entity Type | Organization
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Legal Business Name | GEORGE DEYOUNG
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Dates
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Enumeration Date | 08/03/2009
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Last Update Date | 08/03/2009
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Provider Practice Location Address
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Address Line | 5332 BALMORAL DR
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City | FRISCO
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State | TX
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Zip | 75034-5995
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Country | US
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Telephone | 972-403-3192
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Fax |
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Provider Business Mailing Address
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Address Line | 5332 BALMORAL DR
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City | FRISCO
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State | TX
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Zip | 75034-5995
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Country | US
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Telephone | 972-403-3192
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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. GEORGE GAGE DEYOUNG
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Credential | M.D.
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Telephone | 972-403-3192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | FO442
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | FO442
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License Number State | TX
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