Provider Demographics
NPI:1952503807
Name:YOUNG, ZACHARY TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:TIMOTHY
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8054
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:800-862-9980
Mailing Address - Fax:314-362-1185
Practice Address - Street 1:4500 MEMORIAL DR
Practice Address - Street 2:DEPT ANESTHESIOLOGY
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5360
Practice Address - Country:US
Practice Address - Phone:800-862-9980
Practice Address - Fax:314-362-7785
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036118895207RC0200X, 207RC0200X
MO2016031449207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200036899Medicaid
MO1952503807Medicaid
PA231082VT9Medicare PIN
PA417608OtherUPMC
PA56-2589074OtherINTERGROUP
PA56-2589074OtherHEALTH AMERICA
PA1026778330002Medicaid