Healthcare Provider Details

I. General information

NPI: 1184742520
Provider Name (Legal Business Name): DANIEL ORION YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EDGEWATER PT STE 303
LAKE SAINT LOUIS MO
63367-2954
US

IV. Provider business mailing address

PO BOX 345
COTTLEVILLE MO
63338-0345
US

V. Phone/Fax

Practice location:
  • Phone: 636-265-2225
  • Fax: 636-265-0320
Mailing address:
  • Phone: 636-265-2225
  • Fax: 636-265-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2008002675
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: