Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 72 | OK |
Y | 222Z00000X | Podiatrist | 72 | OK |
N | 224P00000X | Prosthetist | 72 | OK |
NPI | 1265964316 |
---|---|
Provider Name | Joseph Alexander Young |
First Address | Oklahoma City, OK 73142-2710 |
Second Address | Oklahoma City, OK 73142-2710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2017 |
Last Update Date | 29/03/2017 |