Provider Demographics
NPI:1003084484
Name:YOUNGER, ROBERT B (ROLGER)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:YOUNGER
Suffix:
Gender:M
Credentials:ROLGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1648
Mailing Address - Country:US
Mailing Address - Phone:505-889-3333
Mailing Address - Fax:
Practice Address - Street 1:3401 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1648
Practice Address - Country:US
Practice Address - Phone:505-889-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist