Provider Demographics
NPI:1952335259
Name:YOUNG, DONALD JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JEFFREY
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 1:405 LONDONDERRY DR STE 301
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7922
Mailing Address - Country:US
Mailing Address - Phone:254-741-6333
Mailing Address - Fax:254-741-6364
Practice Address - Street 1:405 LONDONDERRY DR STE 301
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7922
Practice Address - Country:US
Practice Address - Phone:254-741-6333
Practice Address - Fax:254-741-6364
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6724174400000X, 2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N59XOtherBLUE CROSS OF TEXAS
TX159499601Medicaid
TX159499601Medicaid
TXG22053Medicare UPIN
TX00973UMedicare ID - Type Unspecified
TXB108110Medicare PIN