Provider Demographics
NPI:1780641621
Name:YOUNG, ANTHONY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 W WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-4521
Mailing Address - Country:US
Mailing Address - Phone:318-283-3607
Mailing Address - Fax:
Practice Address - Street 1:420 GUNBY AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4406
Practice Address - Country:US
Practice Address - Phone:318-283-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102694363AM0700X
FLPA9112036363AM0700X
LAPA.A10295363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS93993Medicare UPIN