Provider Demographics
NPI:1154337046
Name:YOUNG, GREGG K (DPM)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:K
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:VAMC 112
Mailing Address - Street 2:500 FOOTHILL AVE
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84148-0001
Mailing Address - Country:US
Mailing Address - Phone:801-582-1565
Mailing Address - Fax:801-584-2587
Practice Address - Street 1:VAMC 112
Practice Address - Street 2:500 FOOTHILL AVE
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:801-584-2587
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT104906-0501213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Not Answered213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU27288Medicare UPIN