Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 295172-1205 | UT |
N | 207NP0225X | Pediatric Dermatologist | 295172-1205 | UT |
N | 207NS0135X | Procedural Dermatology | 295172-1205 | UT |
NPI | 1013910744 |
---|---|
Provider Name | Dr. Robert P Young |
First Address | North Logan, UT 84341-1202 |
Second Address | North Logan, UT 84341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 18/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G03759 | (02) | UT |