MEDICARE: TONYA J YOUNGBLOOD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	L1249	TX

General Provider Information

NPI Number	:	1295701969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA J YOUNGBLOOD MD

Provider Business Mailing Address
First Line	:	2701 US HIGHWAY 271 N
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-4289
Country	:	US
Telephone Number	:	903-946-5442
Fax Number	:	903-946-5258

Provider Business Practice Location Address
First Line	:	2701 US HIGHWAY 271 N
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-4289
Country	:	US
Telephone Number	:	903-946-5442
Fax Number	:	903-946-5258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	04/15/2020

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