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NPI Code Detail

MEDICARE: TIMOTHY NOEL YOUNG MD

MEDICARE: TIMOTHY NOEL 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
1174400000XSpecialistN4219TX
2207W00000XOphthalmology PhysicianN4219TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00740176OTHERTXRR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number : 1962403071
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY NOEL YOUNG MD
Provider Business Mailing Address
First Line : 5300 NORTH ST
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-1370
Country : US
Telephone Number : 936-569-8278
Fax Number : 936-569-0275
Provider Business Practice Location Address
First Line : 5300 NORTH ST
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-1370
Country : US
Telephone Number : 936-569-8278
Fax Number : 936-569-0275
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 10/01/2012

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Directions to “ TIMOTHY NOEL YOUNG MD” Practice Location

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