Provider Demographics
NPI:1952468290
Name:YOUNG, BOHN MARSHALL (DPM)
Entity Type:Individual
Prefix:DR
First Name:BOHN
Middle Name:MARSHALL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 A SOUTH PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801
Mailing Address - Country:US
Mailing Address - Phone:325-646-0715
Mailing Address - Fax:325-646-3734
Practice Address - Street 1:103 A SOUTH PARK DRIVE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801
Practice Address - Country:US
Practice Address - Phone:325-646-0715
Practice Address - Fax:325-646-3734
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1453213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092724604Medicaid
TX159094501Medicaid
TX092724601Medicaid
TX1590945-01Medicaid
TXU74300Medicare UPIN
TX8A7591Medicare ID - Type Unspecified
TX0033KPOtherBLUE CROSS BLUE SHIELD