Provider Demographics
NPI:1063468924
Name:YOUNGER, CHARLES M (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:M
Last Name:YOUNGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W CUTHBERT AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5729
Mailing Address - Country:US
Mailing Address - Phone:432-684-5848
Mailing Address - Fax:432-684-8017
Practice Address - Street 1:2000 W CUTHBERT AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5729
Practice Address - Country:US
Practice Address - Phone:432-684-5848
Practice Address - Fax:432-684-8017
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5259207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX751477495OtherMISCELLANEOOUS
TXMDD5259TXOtherWORKERS COMP
TX089684702Medicaid
TX127513100OtherFIRST CARE
TX089684702Medicaid
TXC23890Medicare UPIN
TX00T348Medicare PIN