Provider Demographics
NPI:1669662946
Name:HENRY T. YOUNG, JR., M.D.
Entity Type:Organization
Organization Name:HENRY T. YOUNG, JR., M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:225-667-3100
Mailing Address - Street 1:1286 DEL ESTE AVE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4898
Mailing Address - Country:US
Mailing Address - Phone:225-667-3100
Mailing Address - Fax:225-667-5443
Practice Address - Street 1:1286 DEL ESTE AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4898
Practice Address - Country:US
Practice Address - Phone:225-667-3100
Practice Address - Fax:225-667-5443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016391261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1338656Medicaid
LA1338656Medicaid
LA5CA95Medicare PIN