Provider Demographics
NPI:1053399618
Name:YOUNG, DOUGLAS BRYAN (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:BRYAN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W GROVER ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3708
Mailing Address - Country:US
Mailing Address - Phone:704-487-8591
Mailing Address - Fax:704-480-9726
Practice Address - Street 1:200 W GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3708
Practice Address - Country:US
Practice Address - Phone:704-487-8591
Practice Address - Fax:704-480-9726
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24106208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89801OtherBCBS
5060401OtherAETNA NUMBER
NC8989801Medicaid
8508996002OtherCIGNA NUMBER
8508996002OtherCIGNA NUMBER
NC8989801Medicaid