Healthcare Provider Details

I. General information

NPI: 1154999845
Provider Name (Legal Business Name): GRIFFIN YOUNG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GRIFFIN JONES DO

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

1465 S GRAND BLVD RM 2726
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5600
  • Fax:
Mailing address:
  • Phone: 314-577-5680
  • Fax: 314-577-5616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2024039709
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125078953
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: