Active NPI
Gustave Walter Younger III, ATC, LAT
- Athletic Trainer
- Nacogdoches, TX
National Provider Identifier
1770545113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT3062
- Practice address
- Stephen F. Austin State University
Homer Bryce Stadium Field House
Nacogdoches, TX 75962-0001 - Phone
- (936) 468-4550
- Fax
- (936) 468-4052
- NPI assigned
- Apr 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT3062 | TX | Primary |
Addresses
Primary practice location
Stephen F. Austin State University
Homer Bryce Stadium Field House
Nacogdoches, TX 75962-0001
Mailing address
Stephen F. Austin State University
P.O. Box 13010 Sfa Station
Nacogdoches, TX 75962-0001
Phone (936) 468-4550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT3062 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1770545113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "STEPHEN F. AUSTIN STATE UNIVERSITY",
"address_2": "P.O. BOX 13010 SFA STATION",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759620001",
"telephone_number": "936-468-4550",
"fax_number": "936-468-4052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "STEPHEN F. AUSTIN STATE UNIVERSITY",
"address_2": "HOMER BRYCE STADIUM FIELD HOUSE",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759620001",
"telephone_number": "936-468-4550",
"fax_number": "936-468-4052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNGER",
"first_name": "GUSTAVE",
"middle_name": "WALTER",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "ATC, LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT3062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nacogdoches, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.