Provider Demographics
NPI:1225232259
Name:YOUNG, GERALD ALLEN (BC-HIS)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:ALLEN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 W 3RD ST
Mailing Address - Street 2:P.O.BOX 1207
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-3729
Mailing Address - Country:US
Mailing Address - Phone:660-827-1631
Mailing Address - Fax:660-826-1743
Practice Address - Street 1:1118 W 3RD ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-3729
Practice Address - Country:US
Practice Address - Phone:660-827-1631
Practice Address - Fax:660-826-1743
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO467174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist