Provider Demographics
NPI:1659376580
Name:YOUNG, DANIEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
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 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7718
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-939-9665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000131772085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-20588OtherBLUE CROSS
AL515-25898OtherBLUE CROSS
AL103756Medicaid
AL515-31224OtherBLUE CROSS
AL515-97938OtherBLUE CROSS
AL009971980Medicaid
AL510-28143OtherBLUE CROSS
AL009958815Medicaid
AL009993585Medicaid
AL103519Medicaid
AL515-90095OtherBLUE CROSS
AL000028143Medicaid
AL515-04810OtherBLUE CROSS
AL630842160OtherAETNA
C76342Medicare UPIN
AL009993585Medicaid