Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 4792 | AK |
Y | 207L00000X | Anesthesiologist | MD00015269 | WA |
NPI | 1013943745 |
---|---|
Provider Name | Eric A Youngstrom |
First Address | Yakima, WA 98902-3032 |
Second Address | Yakima, WA 98902-3315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 18/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1555101 | (05) | WA |
A07648 | (02) |