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General NPI Number Information
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NPI Number | 1679597256
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Entity Type | Organization
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Legal Business Name | OBSTETRICS AND GYNECOLOGY OF THE WOODLANDS, P.A.
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 17350 ST LUKES WAY SUITE 300
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City | THE WOODLANDS
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State | TX
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Zip | 77384-4100
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Country | US
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Telephone | 281-419-5010
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Fax | 936-273-4418
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Provider Business Mailing Address
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Address Line | 17350 ST LUKES WAY SUITE 300
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City | THE WOODLANDS
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State | TX
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Zip | 77384-4100
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Country | US
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Telephone | 281-419-5010
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Fax | 936-273-4418
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JEROME CLAYTON YOUNG
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Credential | M.D.
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Telephone | 281-419-5010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | J8848
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License Number State | TX
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