Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | S-978 | LA |
NPI | 1053807776 |
---|---|
Provider Name | Dr. Ronald L Young |
First Address | New Orleans, LA 70130-8628 |
Second Address | New Orleans, LA 70119-2715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2018 |
Last Update Date | 05/07/2018 |