Individual
JEROME CLAYTON YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
508 MEDICAL CENTER BLVD, STE 150, CONROE, TX 77304-2953
(936) 760-4600
(936) 760-4601
Mailing address
508 MEDICAL CENTER BLVD, STE 150, CONROE, TX 77304-2953
(936) 760-4600
(936) 760-4601
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
J8848
TX
207V00000X
Obstetrics & Gynecology Physician
Primary
J8848
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10028127
AMERIGROUP ID NUMBER
—
05
—
113255704
—
TX
01
—
8A5130
BLUE CROSS/BLUE SHIELD #
TX
Enumeration date
11/02/2005
Last updated
02/10/2022
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