Provider Demographics
NPI:1730640954
Name:YOUNG, DEREK SCOTT JR (MEDICAL STUDENT)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:SCOTT
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:MEDICAL STUDENT
Other - Prefix:MR
Other - First Name:DEREK
Other - Middle Name:SCOTT
Other - Last Name:STAMBAUGH
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPT. OF INTERNAL MEDICINE MSC 10-5550
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131
Mailing Address - Country:US
Mailing Address - Phone:505-272-6331
Mailing Address - Fax:
Practice Address - Street 1:DEPT. OF INTERNAL MEDICINE MSC 10-5550
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131
Practice Address - Country:US
Practice Address - Phone:505-272-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program