Provider Demographics
NPI:1124124078
Name:WILLIAM BRENT YOUNG MD PA
Entity type:Organization
Organization Name:WILLIAM BRENT YOUNG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-683-6947
Mailing Address - Street 1:1550 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4555
Mailing Address - Country:US
Mailing Address - Phone:352-683-6947
Mailing Address - Fax:352-686-7335
Practice Address - Street 1:1550 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4555
Practice Address - Country:US
Practice Address - Phone:352-683-6947
Practice Address - Fax:352-686-7335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51203Medicare PIN
FL51203AMedicare PIN