Provider Demographics
NPI:1992709869
Name:YOUNG, ANDREW JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOHN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 IMPERIAL DR
Mailing Address - Street 2:STE A
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3948
Mailing Address - Country:US
Mailing Address - Phone:361-578-2777
Mailing Address - Fax:361-578-2778
Practice Address - Street 1:116 IMPERIAL DR
Practice Address - Street 2:STE A
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3948
Practice Address - Country:US
Practice Address - Phone:361-578-2777
Practice Address - Fax:361-578-2778
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1551213E00000X, 213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151244401Medicaid
TXP00140108OtherRAILROAD MEDICARE
TX84532NOtherBCBS PROVIDER NUMBER
TXU85464Medicare UPIN
TXP00140108OtherRAILROAD MEDICARE