Provider Demographics
NPI:1588902076
Name:YOUNG, UMAR DONTAY SR
Entity type:Individual
Prefix:MR
First Name:UMAR
Middle Name:DONTAY
Last Name:YOUNG
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 POWERS AVE
Mailing Address - Street 2:APT 370
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FLA
Mailing Address - Zip Code:32217
Mailing Address - Country:UM
Mailing Address - Phone:904-517-7970
Mailing Address - Fax:904-213-0835
Practice Address - Street 1:7400 POWERS AVE
Practice Address - Street 2:APT 370
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-3943
Practice Address - Country:US
Practice Address - Phone:904-517-7970
Practice Address - Fax:904-213-0835
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker