Healthcare Provider Details

I. General information

NPI: 1053395988
Provider Name (Legal Business Name): STEVEN M YOUNGBLOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 SAINT CHARLES AVE
NEW ORLEANS LA
70130-4445
US

IV. Provider business mailing address

1523 SAINT CHARLES AVE
NEW ORLEANS LA
70130-4445
US

V. Phone/Fax

Practice location:
  • Phone: 504-374-1000
  • Fax: 504-374-1350
Mailing address:
  • Phone: 504-374-1000
  • Fax: 504-374-1350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number200196
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: