Provider Demographics
NPI:1629208558
Name:YOUNG, JOHN BURTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BURTON
Last Name:YOUNG
Suffix:JR
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:P.O. BOX 325
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:MN
Mailing Address - Zip Code:55043-0325
Mailing Address - Country:US
Mailing Address - Phone:651-436-8278
Mailing Address - Fax:
Practice Address - Street 1:2787 ITASCA AVE.
Practice Address - Street 2:
Practice Address - City:ST. MARY'S PT.
Practice Address - State:MN
Practice Address - Zip Code:55043-0325
Practice Address - Country:US
Practice Address - Phone:651-436-8278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18523-020207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology