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NPI Code Detail

MEDICARE: DERICK WAYNE YOUNG MD

MEDICARE: DERICK WAYNE YOUNG 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
1207Q00000XFamily Medicine PhysicianL1502TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2TXB124736OTHERTXWELLMED MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528068350
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERICK WAYNE YOUNG MD
Provider Business Mailing Address
First Line : 5301 39TH ST
Second Line :
City : GROVES
State : TX
Zip : 77619-2911
Country : US
Telephone Number : 409-962-4272
Fax Number : 409-962-2451
Provider Business Practice Location Address
First Line : 5301 39TH ST
Second Line :
City : GROVES
State : TX
Zip : 77619-2911
Country : US
Telephone Number : 409-962-4272
Fax Number : 409-962-2451
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 02/09/2024

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