Provider Demographics
NPI:1942493796
Name:YOUNG, JUAN M (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4211 VAN DYKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-8005
Mailing Address - Country:US
Mailing Address - Phone:813-264-6490
Mailing Address - Fax:813-443-8143
Practice Address - Street 1:4211 VAN DYKE RD STE 200
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8005
Practice Address - Country:US
Practice Address - Phone:813-264-6490
Practice Address - Fax:813-443-8143
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2024-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME105420207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002189700Medicaid
FLDM520YMedicare PIN