Provider Demographics
NPI:1770515868
Name:YOUNG, WALTER CLARK (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:CLARK
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1118 ROSS CLARK CIR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3007
Mailing Address - Country:US
Mailing Address - Phone:334-793-3900
Mailing Address - Fax:334-793-5227
Practice Address - Street 1:1118 ROSS CLARK CIR
Practice Address - Street 2:SUITE 600
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3007
Practice Address - Country:US
Practice Address - Phone:334-793-3900
Practice Address - Fax:334-793-5227
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL11768207V00000X
GA15444207V00000X
VA24486207V00000X
FL44986207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000013710Medicaid
AL009939057Medicaid
AL51012112OtherBCBS
AL051013710OtherBCBS
AL000013710Medicare ID - Type Unspecified
AL000013710Medicaid
AL009939057Medicaid