Provider Demographics
NPI:1114320207
Name:YOUNG, STEVEN (PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:305 CENTER STREET
Mailing Address - City:EAST CARBON
Mailing Address - State:UT
Mailing Address - Zip Code:84520-0930
Mailing Address - Country:US
Mailing Address - Phone:435-888-4411
Mailing Address - Fax:435-888-2270
Practice Address - Street 1:305 CENTER STREET
Practice Address - Street 2:
Practice Address - City:EAST CARBON
Practice Address - State:UT
Practice Address - Zip Code:84520-0930
Practice Address - Country:US
Practice Address - Phone:435-888-4411
Practice Address - Fax:435-888-2270
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9153929-8906363A00000X, 363AM0700X
UT9153929-1206363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical