MEDICARE: RICHARD YOUNG DPM

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	213E00000X	Podiatrist	230	KY
2	213ES0131X	Foot Surgery Podiatrist	230	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	480029186	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1720081417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD YOUNG DPM

Provider Business Mailing Address
First Line	:	1830 DESTINY LN
Second Line	:	SUITE 110
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104
Country	:	US
Telephone Number	:	270-846-3338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 DESTINY LN
Second Line	:	SUITE 110
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104
Country	:	US
Telephone Number	:	270-846-3338
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/11/2008

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Directions to “ RICHARD YOUNG DPM” Practice Location

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