Provider Demographics
NPI:1295207363
Name:YOUNG, PETER ASHTON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:ASHTON
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FOUR MILE DR STE 7
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2655
Mailing Address - Country:US
Mailing Address - Phone:406-314-6336
Mailing Address - Fax:
Practice Address - Street 1:40 FOUR MILE DR STE 7
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2655
Practice Address - Country:US
Practice Address - Phone:406-314-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-29
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-LIC-70415207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology