Provider Demographics
NPI:1235543430
Name:YOUNGBLOOD, KNEEL AND (MD)
Entity Type:Individual
Prefix:
First Name:KNEEL AND
Middle Name:
Last Name:YOUNGBLOOD
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 1:300 CRESCENT CT
Mailing Address - Street 2:#1380
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1876
Mailing Address - Country:US
Mailing Address - Phone:214-855-0194
Mailing Address - Fax:214-855-1230
Practice Address - Street 1:300 CRESCENT CT
Practice Address - Street 2:#1380
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-1876
Practice Address - Country:US
Practice Address - Phone:214-855-0194
Practice Address - Fax:214-855-1230
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3929207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine