Provider Demographics
NPI:1184742520
Name:YOUNG, DANIEL ORION (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ORION
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 JUNGERMANN CIR STE 302
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1637
Mailing Address - Country:US
Mailing Address - Phone:636-720-0310
Mailing Address - Fax:636-720-0311
Practice Address - Street 1:70 JUNGERMANN CIR STE 302
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1637
Practice Address - Country:US
Practice Address - Phone:636-720-0310
Practice Address - Fax:636-720-0311
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22516207R00000X
MO2008002675207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO330454027OtherMEDICARE PTAN
MO208397505Medicaid
MO330454027OtherMEDICARE PTAN