Provider Demographics
NPI:1548651094
Name:YOUNG, MATTHEW PRATT (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PRATT
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 190930
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0930
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:3601 4TH STREET
Practice Address - Street 2:MAIL STOP 9901
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:806-743-2757
Practice Address - Fax:806-743-1180
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDYC356923G1041S0200X
TXT9288207Q00000X, 207R00000X
390200000X
IDM-17572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program