Provider Demographics
NPI:1790727691
Name:YOUNG, GREGORY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALAN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1320 SUMMER LEE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5453
Mailing Address - Country:US
Mailing Address - Phone:972-771-5443
Mailing Address - Fax:972-771-5444
Practice Address - Street 1:1005 W RALPH HALL
Practice Address - Street 2:SUITE 107
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6653
Practice Address - Country:US
Practice Address - Phone:972-771-5443
Practice Address - Fax:972-771-5444
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7395207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00895YMedicare ID - Type UnspecifiedPREVIOUS GROUP NUMBER
TX8F1279Medicare ID - Type UnspecifiedINDIVIDUAL ID
TXG05045Medicare UPIN
TX00587ZMedicare ID - Type UnspecifiedGROUP NUMBER
TX805872Medicare ID - Type UnspecifiedPREVIOUS INDIVIDUAL ID #