Provider Demographics
NPI:1851736045
Name:JOHN L. YOUNG, M.D.
Entity Type:Organization
Organization Name:JOHN L. YOUNG, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-989-0548
Mailing Address - Street 1:14 REDGATE CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-5726
Mailing Address - Country:US
Mailing Address - Phone:301-989-0548
Mailing Address - Fax:301-989-1543
Practice Address - Street 1:4101 MEXICO RD
Practice Address - Street 2:SUITE H
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6414
Practice Address - Country:US
Practice Address - Phone:301-989-0548
Practice Address - Fax:301-989-1543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012008874208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012008874OtherMEDICAL LICENSE