Healthcare Provider Details

I. General information

NPI: 1407411093
Provider Name (Legal Business Name): DREW ALLEN YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 E PRIMROSE ST
SPRINGFIELD MO
65804-4278
US

IV. Provider business mailing address

1265 E PRIMROSE ST
SPRINGFIELD MO
65804-4278
US

V. Phone/Fax

Practice location:
  • Phone: 417-886-3937
  • Fax: 417-877-0091
Mailing address:
  • Phone: 417-886-3937
  • Fax: 417-877-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2023022123
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: