1720072333 NPI number — DR. JEFFREY MILTON YOUNG M.D.

Table of content: DR. JEFFREY MILTON YOUNG M.D. (NPI 1720072333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720072333 NPI number — DR. JEFFREY MILTON YOUNG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
JEFFREY
Provider Middle Name:
MILTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720072333
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1659 SENTIERO DELLA VILLA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87506-4502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-920-0488
Provider Business Mailing Address Fax Number:
858-832-8163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 S LOLA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89048-0884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-751-7561
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  A34567 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 6126 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: MD2006-0062 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: MD13719 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)