Provider Demographics
NPI:1689654014
Name:YOUNG, LARRY CRESTON (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:CRESTON
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:345 23RD AVE NORTH
Mailing Address - Street 2:SUITE 412
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-321-4545
Mailing Address - Fax:615-321-5565
Practice Address - Street 1:345 23RD AVE NORTH
Practice Address - Street 2:SUITE 412
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-321-4545
Practice Address - Fax:615-321-5565
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2014-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN011840207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B03790Medicare UPIN
TN3177965Medicare ID - Type Unspecified