Provider Demographics
NPI:1962403071
Name:YOUNG, TIMOTHY NOEL (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:NOEL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1370
Mailing Address - Country:US
Mailing Address - Phone:936-569-8278
Mailing Address - Fax:936-569-0275
Practice Address - Street 1:5300 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1370
Practice Address - Country:US
Practice Address - Phone:936-569-8278
Practice Address - Fax:936-569-0275
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4219174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00740176OtherRR MEDICARE
TX2057937-01Medicaid
TX8L17666Medicare PIN
TXP00740176OtherRR MEDICARE