Provider Demographics
NPI:1851301204
Name:YOUNG, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
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 1:1020 S STATE HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4471
Mailing Address - Country:US
Mailing Address - Phone:501-545-9910
Mailing Address - Fax:
Practice Address - Street 1:1020 S STATE HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4471
Practice Address - Country:US
Practice Address - Phone:501-545-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0011207Q00000X
NC2019-02461207Q00000X
NY307784207Q00000X
AL00041561207Q00000X
OH35.136341207Q00000X
OK29064207Q00000X
IL036152980207Q00000X
SC52754207Q00000X
NJ25MA11002300207Q00000X
NH18154207Q00000X
AZ56860207Q00000X
CODR.0063249207Q00000X
SD10285207Q00000X
TXN4218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130921001Medicaid
AR930055542OtherRAILROAD THRU WCMC
ARPOO692620OtherRAILROAD MEDICARE
ARPOO692620OtherRAILROAD MEDICARE
AR5K336Medicare PIN
AR930055542OtherRAILROAD THRU WCMC
AR5H942B637Medicare PIN