Provider Demographics
NPI:1699793190
Name:YOUNG, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR
Mailing Address - Street 2:SUITE 510
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1951
Mailing Address - Country:US
Mailing Address - Phone:903-595-2636
Mailing Address - Fax:903-595-5560
Practice Address - Street 1:700 OLYMPIC PLAZA CIR
Practice Address - Street 2:SUITE 510
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1951
Practice Address - Country:US
Practice Address - Phone:903-595-2636
Practice Address - Fax:903-595-5560
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK8591208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085672602OtherGROUP MEDICAID NUMBER
TX752605101OtherFEIN
TX00U48ZOtherGROUP MEDICARE NUMBER
TX8J9152OtherINDIVIDUAL MEDICARE NUMBER
TX038850603Medicaid