Provider Demographics
NPI:1306292339
Name:DEYOUNG, ADAM MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:MICHAEL
Last Name:DEYOUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4148
Mailing Address - Country:US
Mailing Address - Phone:407-889-4711
Mailing Address - Fax:407-889-7742
Practice Address - Street 1:202 N PARK AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4148
Practice Address - Country:US
Practice Address - Phone:407-889-4711
Practice Address - Fax:407-889-7742
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16859207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program