Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 5101021818 | MI |
Y | 207P00000X | Emergency Physician | 73154-21 | WI |
N | 207P00000X | Emergency Physician | S0411 | TX |
N | 207PE0004X | Emergency Medical Services | 73154-21 | WI |
N | 207PE0004X | Emergency Medical Services | S0411 | TX |
NPI | 1053792895 |
---|---|
Provider Name | Dr. Ethan James Young |
First Address | Eau Claire, WI 54701-6122 |
Second Address | Chippewa Falls, WI 54729-5407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2015 |
Last Update Date | 16/12/2021 |