1538249479 NPI number — JOHN G YOUNG MD

Table of content: JOHN G YOUNG MD (NPI 1538249479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538249479 NPI number — JOHN G YOUNG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
JOHN
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538249479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6210 JOHN RYAN DR
Provider Second Line Business Mailing Address:
STE 109
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76132-4113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-361-7494
Provider Business Mailing Address Fax Number:
817-361-0705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6210 JOHN RYAN DR
Provider Second Line Business Practice Location Address:
STE 109
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76132-4113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-361-7494
Provider Business Practice Location Address Fax Number:
817-361-0705
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  G8527 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2917579 . This is a "CIGNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1416762 . This is a "FIRSTHEALTH PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 132731 . This is a "UHC PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4525787 . This is a "AETNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 82Y880 . This is a "BCBSTX IND PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: YOUJE76947 . This is a "CCHIP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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