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NPI Code Detail

MEDICARE: DR. LISA DYER YOUNG M.D.

MEDICARE: DR. LISA DYER YOUNG M.D.
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
1208000000XPediatrics Physician21253AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
121253OTHERALALABAMA CONTR SUBST CERT
236452OTHERAMERICAN BOARD PEDIATRICS
3510-96615OTHERALBCBS AL PROV # AUBURN
4177521OTHERAAP ID
521253OTHERALALABAMA MEDICAL LICENSE
6510-96612OTHERALBCBS AL PROV # OPELIKA
71210778OTHERALUNITED HEALTH PROV #

General Provider Information

NPI Number : 1922149798
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA DYER YOUNG M.D.
Provider Business Mailing Address
First Line : 2401 VILLAGE PROFESSIONAL DRIVE
Second Line :
City : OPELIKA
State : AL
Zip : 36801-4702
Country : US
Telephone Number : 334-749-8121
Fax Number : 334-749-6166
Provider Business Practice Location Address
First Line : 2401 VILLAGE PROFESSIONAL DRIVE
Second Line :
City : OPELIKA
State : AL
Zip : 36801-4702
Country : US
Telephone Number : 334-749-8121
Fax Number : 334-749-6166
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 03/07/2023

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