Provider Demographics
NPI:1023043338
Name:YOUNG, ROBERT S JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 6210
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-6210
Mailing Address - Country:US
Mailing Address - Phone:505-609-2258
Mailing Address - Fax:505-609-2259
Practice Address - Street 1:4820 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8660
Practice Address - Country:US
Practice Address - Phone:505-609-6495
Practice Address - Fax:505-609-6496
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM95-165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000R7247Medicaid
NMD62700Medicare UPIN