Provider Demographics
NPI:1346277449
Name:YOUNG, CLINTON (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
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 1:2020 W PINHOOK RD
Mailing Address - Street 2:SUITE 506
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3290
Mailing Address - Country:US
Mailing Address - Phone:337-504-3970
Mailing Address - Fax:337-456-1512
Practice Address - Street 1:2020 W PINHOOK RD
Practice Address - Street 2:SUITE 506
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3290
Practice Address - Country:US
Practice Address - Phone:337-504-3970
Practice Address - Fax:337-456-1512
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.013294207R00000X
LA013294207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1181625Medicaid
LAB60516Medicare UPIN
LA1181625Medicaid