Provider Demographics
NPI:1427024074
Name:YOUNG, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 632189
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-2189
Mailing Address - Country:US
Mailing Address - Phone:936-559-9019
Mailing Address - Fax:936-462-7876
Practice Address - Street 1:320 RUSSELL BLVD
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1240
Practice Address - Country:US
Practice Address - Phone:936-559-9019
Practice Address - Fax:936-462-7876
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4616208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BF233OtherBCBS IND
TX0045LBOtherBCBS
TX038536102Medicaid
P00109502Medicare PIN
TX8B8869Medicare PIN
TX038536102Medicaid
TXTXB130477Medicare PIN