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General NPI Number Information
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NPI Number | 1285752824
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Entity Type | Organization
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Legal Business Name | JERRY D. YOUNG, D.O., P.A.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 02/05/2011
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Provider Practice Location Address
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Address Line | 740 12TH ST
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City | BAY CITY
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State | TX
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Zip | 77414-2904
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Country | US
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Telephone | 979-244-1317
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Fax | 979-244-8993
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Provider Business Mailing Address
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Address Line | PO BOX 203059
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City | DALLAS
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State | TX
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Zip | 75320-3059
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Country | US
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Telephone | 979-244-1317
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Fax | 979-244-8993
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Authorized Official
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Title or Position | OWNER
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Name | DR. JERRY D. YOUNG
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Credential | D.O.
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Telephone | 979-244-1317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | J4630
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License Number State | TX
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