Provider Demographics
NPI:1417939414
Name:YOUNG, KEITH P (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:P
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 1:400 N STATE OF FRANKLIN RD RM 2746
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6035
Mailing Address - Country:US
Mailing Address - Phone:423-431-2727
Mailing Address - Fax:423-431-6715
Practice Address - Street 1:400 N STATE OF FRANKLIN RD RM 2746
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6035
Practice Address - Country:US
Practice Address - Phone:423-431-2727
Practice Address - Fax:423-431-6715
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15563207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1477599223OtherGROUP NPI
AL529912020Medicaid
AL51510627OtherBLUE CROSS OF AL
051552035Medicare ID - Type Unspecified
1477599223OtherGROUP NPI