Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | C-5255 | AR |
NPI | 1124411095 |
---|---|
Provider Name | Robert P Young |
First Address | Little Rock, AR 72212-4177 |
Second Address | Little Rock, AR 72212-4177 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2015 |
Last Update Date | 16/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C-5255 | LICENSE NUMBER (01) | AR |