Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD06578 | OR |
NPI | 1013900059 |
---|---|
Provider Name | Donald Andrew Young III |
First Address | Portland, OR 97232-2684 |
Second Address | Portland, OR 97213-2991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 16/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
220475 | (05) | OR |
8199366 | (05) | WA |
C94135 | (02) | OR |