Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 0420011205 | VT |
Y | 207VG0400X | Gynecologist | 49929 | TN |
NPI | 1114036027 |
---|---|
Provider Name | Dr. Roger Charles Young |
First Address | Memphis, TN 38120-2611 |
Second Address | Memphis, TN 38103-2807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 18/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1532794 | (05) | TN |
198892001 | (05) | AR |
9202025 | (05) | MS |