Provider Demographics
NPI:1912455155
Name:CHARLES C YOUNG MD LLC
Entity Type:Organization
Organization Name:CHARLES C YOUNG MD LLC
Other - Org Name:CHARLES YOUNG MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-324-6711
Mailing Address - Street 1:1812 DALEY ST
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5912
Mailing Address - Country:US
Mailing Address - Phone:307-324-6711
Mailing Address - Fax:307-324-3594
Practice Address - Street 1:1812 DALEY ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5912
Practice Address - Country:US
Practice Address - Phone:307-324-6711
Practice Address - Fax:307-324-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty