Provider Demographics
NPI:1629075379
Name:YOUNGER, DAVID GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GEORGE
Last Name:YOUNGER
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:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:NE
Mailing Address - Zip Code:69033-0819
Mailing Address - Country:US
Mailing Address - Phone:308-882-7111
Mailing Address - Fax:308-882-7317
Practice Address - Street 1:600 W 12TH ST
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:NE
Practice Address - Zip Code:69033-3130
Practice Address - Country:US
Practice Address - Phone:308-882-7111
Practice Address - Fax:308-882-7317
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-21407207Q00000X
NE28175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100399640BMedicaid
KS415240OtherFIRSTGUARD
KS103519Medicare ID - Type UnspecifiedBCBS
KS100399640BMedicaid