Provider Demographics
NPI:1831357219
Name:YOUNG, LAWRENCE JOHN JR (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOHN
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3033 EXCELSIOR BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4674
Mailing Address - Country:US
Mailing Address - Phone:612-438-3255
Mailing Address - Fax:612-438-3255
Practice Address - Street 1:3033 EXCELSIOR BLVD STE 210
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4674
Practice Address - Country:US
Practice Address - Phone:612-438-3255
Practice Address - Fax:612-438-3255
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN535212084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN260003371Medicare PIN