Provider Demographics
NPI:1013970441
Name:YOUNGMAN, DARRELL J (DO)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:J
Last Name:YOUNGMAN
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:PO BOX 2969
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-2969
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9769
Practice Address - Street 1:3311 E MURDOCK ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3054
Practice Address - Country:US
Practice Address - Phone:316-689-9370
Practice Address - Fax:316-689-9363
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0322326207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS003719302OtherMEDICARE
KS100184900CMedicaid
120001354OtherRAILROAD MEDICARE
KS100184900KMedicaid
KS003719302OtherMEDICARE
KS022601Medicare PIN