Basic Information
| Provider Information | |||||||||
| NPI: | 1790727691 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 SUMMER LEE DR | ||||||||
| Address2: | |||||||||
| City: | ROCKWALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750325453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727715443 | ||||||||
| FaxNumber: | 9727715444 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 W RALPH HALL | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | ROCKWALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750326653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727715443 | ||||||||
| FaxNumber: | 9727715444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 09/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | J7395 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.