Provider Demographics
NPI:1689745143
Name:YOUNG, ALAN KEITH (M D)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:KEITH
Last Name:YOUNG
Suffix:
Gender:M
Credentials:M D
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 3607
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77805-3607
Mailing Address - Country:US
Mailing Address - Phone:979-779-6615
Mailing Address - Fax:979-823-2758
Practice Address - Street 1:1404 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-1919
Practice Address - Country:US
Practice Address - Phone:979-779-6615
Practice Address - Fax:979-823-2785
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5417208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX878517OtherBLUE CROSS BLUE SHIELD NO
TX105491802Medicaid
TX340004372OtherMEDICARE RAILROAD
TX878517OtherBLUE CROSS BLUE SHIELD NO
TX105491802Medicaid