Organization
JERRY D. YOUNG, D.O., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY D. YOUNG D.O. (OWNER)
(979) 244-1317
Entity
Organization
Contact information
Practice address
740 12TH ST, BAY CITY, TX 77414-2904
(979) 244-1317
(979) 244-8993
Mailing address
PO BOX 203059, DALLAS, TX 75320-3059
(979) 244-1317
(979) 244-8993
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
J4630
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00Y859
MEDICARE ID - TYPE UNSPECIFIED
TX
05
—
122021202
—
TX
Enumeration date
03/26/2007
Last updated
02/05/2011
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