Jerry D. Young, D.O., P.a.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

J4630 Issued in TX

Legal business name

JERRY D. YOUNG, D.O., P.A.

Practice address

740 12TH St
Bay City, TX 77414-2904

Phone

(979) 244-1317

Fax

(979) 244-8993

NPI assigned

Mar 26, 2007

Last updated

Feb 5, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jerry D. Young, D.O.

Title

Owner

Phone

(979) 244-1317

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296864000000",
    "number": "1285752824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 203059",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753203059",
            "telephone_number": "979-244-1317",
            "fax_number": "979-244-8993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 12TH ST",
            "city": "BAY CITY",
            "state": "TX",
            "postal_code": "774142904",
            "telephone_number": "979-244-1317",
            "fax_number": "979-244-8993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY D. YOUNG, D.O., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2011-02-05",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "979-244-1317",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "J4630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122021202",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID - TYPE UNSPECIFIED",
            "identifier": "00Y859",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Bay City, TX
• Providers in Bay City, TX by specialty
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.