Individual
JAKE YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3811 SAGEBRIAR DR, BRYAN, TX 77802-6107
(979) 774-0498
(979) 774-7673
Mailing address
3811 SAGEBRIAR DR, BRYAN, TX 77802-6107
(979) 774-0498
(979) 774-7673
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
BP20076833
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BP20076833
—
TX
Enumeration date
03/24/2020
Last updated
05/03/2024
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