Healthcare Provider Details

I. General information

NPI: 1619907672
Provider Name (Legal Business Name): PATRICK PETER YEUNG JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12812 TESSON FERRY RD
SAINT LOUIS MO
63128-2913
US

IV. Provider business mailing address

12812 TESSON FERRY RD
SAINT LOUIS MO
63128-2913
US

V. Phone/Fax

Practice location:
  • Phone: 314-970-1040
  • Fax: 314-970-1042
Mailing address:
  • Phone: 314-970-1040
  • Fax: 314-970-1042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2002002871
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2008-00669
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberTP157
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: