Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 09436R | LA |
N | 2080P0205X | Pediatric Endocrinologist | MD09436R | LA |
NPI | 1326087941 |
---|---|
Provider Name | Dr. Martin C Young |
First Address | Monroe, LA 71201-7257 |
Second Address | Monroe, LA 71201-7257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 03/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1937657 | (05) | LA |
F37536 | (02) | LA |