Provider Demographics
NPI:1538252077
Name:YOUNG, CHARLES C (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
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 1:1812 DALEY ST
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5912
Mailing Address - Country:US
Mailing Address - Phone:307-324-6711
Mailing Address - Fax:307-324-3594
Practice Address - Street 1:1812 DALEY ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5912
Practice Address - Country:US
Practice Address - Phone:307-324-6711
Practice Address - Fax:307-324-3594
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5353A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY344550OtherCOMBINED INSURANCE
WY307083OtherBLUE CROSS BLUE SHIELD
WY109204900Medicaid
WY5353AOtherLICENSE
WY850335622OtherTAX ID
WY080086864OtherPALMETTO
WY53D0909290OtherCLIA
WY490301955OtherLAB CORP
WY563365OtherWY WORKERS COMPENSATION
WY563365OtherWY WORKERS COMPENSATION
WYD43367Medicare UPIN
WYW307083Medicare ID - Type Unspecified