Provider Demographics
NPI:1568444388
Name:YOUNG, LAWRENCE (PA-C)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 AIR PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-3000
Mailing Address - Country:US
Mailing Address - Phone:903-408-5834
Mailing Address - Fax:903-408-5693
Practice Address - Street 1:1705 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75428-2551
Practice Address - Country:US
Practice Address - Phone:903-886-8818
Practice Address - Fax:903-886-8765
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01326363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111557802Medicaid
TXS77656Medicare UPIN
TX111557802Medicaid