Provider Demographics
NPI:1922356328
Name:YOUNG, DANIEL WILSON (IDC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:WILSON
Last Name:YOUNG
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS JOHN C STENNIS (CVN 74)
Mailing Address - Street 2:BOX 67
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96615-2874
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USS STENNIS (CVN-74)
Practice Address - Street 2:MEDICAL DEPARTMENT
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96615-2874
Practice Address - Country:US
Practice Address - Phone:360-340-4941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman