Provider Demographics
NPI:1386631828
Name:YOUNG, THOMAS P (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 165TH ST
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-8348
Mailing Address - Country:US
Mailing Address - Phone:641-344-0887
Mailing Address - Fax:641-782-6515
Practice Address - Street 1:1700 W TOWNLINE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1054
Practice Address - Country:US
Practice Address - Phone:641-782-6440
Practice Address - Fax:641-782-6515
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1031757Medicaid
00810Medicare ID - Type Unspecified
IA1031757Medicaid