Organization
LIVE YOUNG MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW JAMES BONHAM (V.P OPERATIONS)
(402) 681-4829
Entity
Organization
Contact information
Practice address
112 GAUL DR, SERGEANT BLUFF, IA 51054-8963
(402) 681-8662
Mailing address
112 GAUL DR, SERGEANT BLUFF, IA 51054-8963
(402) 681-8662
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/16/2024
Last updated
07/16/2024
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