Provider Demographics
NPI:1730718016
Name:YOUNGBLOOD, WESLEY WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:WAYNE
Last Name:YOUNGBLOOD
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 1:196 CEDAR POINTE DR
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MS
Mailing Address - Zip Code:39740-8649
Mailing Address - Country:US
Mailing Address - Phone:662-242-0888
Mailing Address - Fax:
Practice Address - Street 1:1301 MATTEC DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-7300
Practice Address - Country:US
Practice Address - Phone:513-454-7246
Practice Address - Fax:513-986-5069
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.15258207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology