Provider Demographics
NPI:1336329457
Name:JAMES R. YOUNG MD
Entity Type:Organization
Organization Name:JAMES R. YOUNG MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-559-9019
Mailing Address - Street 1:4800 NE STALLINGS DR
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1249
Mailing Address - Country:US
Mailing Address - Phone:936-559-9019
Mailing Address - Fax:936-462-7876
Practice Address - Street 1:4800 NE STALLINGS DR
Practice Address - Street 2:SUITE 1600
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1249
Practice Address - Country:US
Practice Address - Phone:936-559-9019
Practice Address - Fax:936-462-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4616208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0045LBOtherBC/BS
TX0089RMOtherBCBS
TX165815501Medicaid
TX0089RMOtherBCBS
DB4956Medicare PIN
TX165815501Medicaid