Provider Demographics
NPI:1164560413
Name:DAVID F. YOUNG MDPC
Entity Type:Organization
Organization Name:DAVID F. YOUNG MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:541-479-3367
Mailing Address - Street 1:1309 NE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1293
Mailing Address - Country:US
Mailing Address - Phone:541-479-3367
Mailing Address - Fax:541-479-0215
Practice Address - Street 1:1309 NE 6TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1293
Practice Address - Country:US
Practice Address - Phone:541-479-3367
Practice Address - Fax:541-479-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12726174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R0000WCNGNMedicare PIN