Provider Demographics
NPI:1538249479
Name:YOUNG, JOHN G (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6210 JOHN RYAN DR
Mailing Address - Street 2:STE 109
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4113
Mailing Address - Country:US
Mailing Address - Phone:817-361-7494
Mailing Address - Fax:817-361-0705
Practice Address - Street 1:6210 JOHN RYAN DR
Practice Address - Street 2:STE 109
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4113
Practice Address - Country:US
Practice Address - Phone:817-361-7494
Practice Address - Fax:817-361-0705
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2012-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG8527208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2917579OtherCIGNA PIN
TX1416762OtherFIRSTHEALTH PIN
TX132731OtherUHC PIN
TX4525787OtherAETNA PIN
TX82Y880OtherBCBSTX IND PIN
TXYOUJE76947OtherCCHIP PIN
E76947Medicare UPIN