Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD38683 | TN |
NPI | 1134236052 |
---|---|
Provider Name | Dr. Richard Michael Young |
First Address | Knoxville, TN 37950-2948 |
Second Address | Knoxville, TN 37919-4858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 03/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3895843 | (05) | TN |
G40639 | (02) |