Provider Demographics
NPI:1790894830
Name:YOUNG, EVELYN (MD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3619 RICHARDSON SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-6022
Mailing Address - Country:US
Mailing Address - Phone:636-717-6700
Mailing Address - Fax:636-464-6755
Practice Address - Street 1:3619 RICHARDSON SQUARE DR
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-6022
Practice Address - Country:US
Practice Address - Phone:636-717-6700
Practice Address - Fax:636-464-6755
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC07348207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR115437001Medicaid
AR930117568Medicare PIN
AR115437001Medicaid
AR52317Medicare PIN