Healthcare Provider Details

I. General information

NPI: 1710130919
Provider Name (Legal Business Name): LEE HUNTER YOUNG P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9556 MANCHESTER RD
SAINT LOUIS MO
63119-1313
US

IV. Provider business mailing address

9556 MANCHESTER RD
SAINT LOUIS MO
63119-1313
US

V. Phone/Fax

Practice location:
  • Phone: 314-961-2255
  • Fax: 314-373-5757
Mailing address:
  • Phone: 314-373-5740
  • Fax: 314-373-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number085-003338
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number085.003338
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: