Provider Demographics
NPI:1083694665
Name:YOUNG, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:YOUNG
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 1:1150 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3022
Mailing Address - Country:US
Mailing Address - Phone:334-712-1929
Mailing Address - Fax:334-712-2799
Practice Address - Street 1:1150 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3022
Practice Address - Country:US
Practice Address - Phone:334-712-1929
Practice Address - Fax:334-712-2799
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16584207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370489100Medicaid
FL370489101Medicaid
AL051088715OtherBLUE CROSS
FL370489102Medicaid
AL000088715Medicaid
AL051540112OtherBLUE CROSS
GA00505689BMedicaid
FL61700OtherBLUE CROSS
631087996OtherTAX ID#
AL009942275Medicaid
AL051055300OtherBLUE CROSS
AL051095000OtherBLUE CROSS
AL000088715Medicare ID - Type Unspecified
AL051055300OtherBLUE CROSS
FL61700ZMedicare ID - Type Unspecified
AL000095000Medicare PIN
FL61700OtherBLUE CROSS
AL051540112OtherBLUE CROSS
AL051095000OtherBLUE CROSS