Provider Demographics
NPI:1104867126
Name:YOUNG, JERROLD (MD)
Entity type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6200 SUNSET DR
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4828
Mailing Address - Country:US
Mailing Address - Phone:305-667-7878
Mailing Address - Fax:305-667-7459
Practice Address - Street 1:6200 SUNSET DR
Practice Address - Street 2:SUITE 501
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4828
Practice Address - Country:US
Practice Address - Phone:305-667-7878
Practice Address - Fax:305-667-7459
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME21428208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78188AOtherINDIVIDUAL MEDICARE PTAN
FL78188AOtherINDIVIDUAL MEDICARE PTAN