Provider Demographics
NPI:1962492769
Name:YOUNG, PAUL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
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 - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 PARK CENTER DR STE 130
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7611
Mailing Address - Country:US
Mailing Address - Phone:321-842-7888
Mailing Address - Fax:321-842-9338
Practice Address - Street 1:2101 PARK CENTER DR STE 130
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7611
Practice Address - Country:US
Practice Address - Phone:321-842-7888
Practice Address - Fax:321-842-9338
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME64622208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269245700Medicaid
FL23585ZMedicare ID - Type Unspecified
FL340007701OtherRAILROAD MEDICARE
FL23585OtherBLUECROSS/BLUESHIELD
FL269245700Medicaid