Provider Demographics
NPI:1346350683
Name:MOO YOUNG, KARL JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:JAMES
Last Name:MOO YOUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2600 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3011
Mailing Address - Country:US
Mailing Address - Phone:910-272-3051
Mailing Address - Fax:910-738-3764
Practice Address - Street 1:128 E BROAD ST
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-1610
Practice Address - Country:US
Practice Address - Phone:910-865-5955
Practice Address - Fax:910-738-3764
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2008-01645207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910357Medicaid
NC150YKOtherBCBS
NC2023025AMedicare PIN
NC150YKOtherBCBS