Provider Demographics
NPI:1457392045
Name:YOUNG, JOHN PATRICK (M D)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:YOUNG
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MONTGOMERY HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1896
Mailing Address - Country:US
Mailing Address - Phone:205-822-9595
Mailing Address - Fax:205-822-4733
Practice Address - Street 1:200 MONTGOMERY HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-1896
Practice Address - Country:US
Practice Address - Phone:205-822-9595
Practice Address - Fax:205-822-4733
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22648174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510I200074Medicare PIN
ALH10558Medicare UPIN