Basic Information
| Provider Information | |||||||||
| NPI: | 1194772152 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2214 CANTERBURY DR STE 202 | ||||||||
| Address2: | |||||||||
| City: | HAYS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676012375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856232312 | ||||||||
| FaxNumber: | 7856232323 | ||||||||
| Practice Location | |||||||||
| Address1: | 2214 CANTERBURY DR STE 202 | ||||||||
| Address2: | |||||||||
| City: | HAYS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676012375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856232312 | ||||||||
| FaxNumber: | 7856232323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 11/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME77468 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0426481 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2581138800 | 05 | FL | MEDICAID |