Provider Demographics
NPI:1063781870
Name:YOUNG, GREGORY WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WALTER
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6512 LAGUNA PARK DR
Mailing Address - Street 2:ELK GROVE
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4856
Mailing Address - Country:US
Mailing Address - Phone:916-678-0045
Mailing Address - Fax:888-370-2396
Practice Address - Street 1:6512 LAGUNA PARK DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-4856
Practice Address - Country:US
Practice Address - Phone:209-274-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG843682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry