Healthcare Provider Details

I. General information

NPI: 1457392045
Provider Name (Legal Business Name): JOHN PATRICK YOUNG M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MONTGOMERY HWY SUITE 200
BIRMINGHAM AL
35216-1896
US

IV. Provider business mailing address

200 MONTGOMERY HWY SUITE 200
BIRMINGHAM AL
35216-1896
US

V. Phone/Fax

Practice location:
  • Phone: 205-822-9595
  • Fax: 205-822-4733
Mailing address:
  • Phone: 205-822-9595
  • Fax: 205-822-4733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number22648
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: