Provider Demographics
NPI:1710028550
Name:YOUNG, VERNON LEROY (MD)
Entity Type:Individual
Prefix:MR
First Name:VERNON
Middle Name:LEROY
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 1:901 PATIENTS FIRST DRIVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090
Mailing Address - Country:US
Mailing Address - Phone:636-390-1544
Mailing Address - Fax:636-390-1451
Practice Address - Street 1:901 PATIENTS FIRST DRIVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090
Practice Address - Country:US
Practice Address - Phone:636-390-1544
Practice Address - Fax:636-390-1451
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9606208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO001013647Medicare ID - Type UnspecifiedMEDICARE NUMBER
MOA12816Medicare UPIN