Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MD161505 | OR |
N | 207RP1001X | Pulmonary Disease | MD161505 | OR |
NPI | 1013273804 |
---|---|
Provider Name | Dr. Andrew T Young |
First Address | Medford, OR 97501-0132 |
Second Address | Medford, OR 97504-7134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2012 |
Last Update Date | 31/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500654440 | (05) | OR |