Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 2014-00341 | NC |
NPI | 1093987794 |
---|---|
Provider Name | James Robert Young |
First Address | Charlotte, NC 28211-0035 |
Second Address | Charlotte, NC 28211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2008 |
Last Update Date | 27/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093987794 | (05) | NC |
400341 | (05) | SC |
NCQ482B | MEDICARE - NC (01) | NC |