Provider Demographics
NPI:1861496739
Name:YOUNG, DONALD CARLETON (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CARLETON
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 NW 121ST ST
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8143
Mailing Address - Country:US
Mailing Address - Phone:515-222-3060
Mailing Address - Fax:515-222-9563
Practice Address - Street 1:1371 NW 121ST ST
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8143
Practice Address - Country:US
Practice Address - Phone:515-222-3060
Practice Address - Fax:515-222-9563
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02198207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0096727Medicaid
IA09548Medicare ID - Type Unspecified
IA0096727Medicaid