Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | 01075557A | IN |
NPI | 1003886862 |
---|---|
Provider Name | Robert Young |
First Address | Indianapolis, IN 46202-5166 |
Second Address | Indianapolis, IN 46202-5166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 10/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1000034161 | (05) | DE |
I07339 | (02) |