Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | R3831 | AR |
NPI | 1194773861 |
---|---|
Provider Name | Dr. Thomas Hunter Youngblood |
First Address | Lowell, AR 72745-9704 |
Second Address | Lowell, AR 72745-9704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 04/12/2015 |