Provider Demographics
NPI:1104092915
Name:RODNEY YOUNG MD PA
Entity type:Organization
Organization Name:RODNEY YOUNG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-835-1811
Mailing Address - Street 1:1190 NW 95TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2066
Mailing Address - Country:US
Mailing Address - Phone:305-835-1811
Mailing Address - Fax:305-835-9606
Practice Address - Street 1:1190 NW 95TH ST STE 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2066
Practice Address - Country:US
Practice Address - Phone:305-835-1811
Practice Address - Fax:305-835-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-0040260174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040128500Medicaid
FLME-0040260OtherLIC #