Provider Demographics
NPI:1326137274
Name:YOUNG, GLADYS (MD)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MT
Mailing Address - Zip Code:59522-0506
Mailing Address - Country:US
Mailing Address - Phone:406-759-5194
Mailing Address - Fax:
Practice Address - Street 1:418 W MONROE AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MT
Practice Address - Zip Code:59522-0506
Practice Address - Country:US
Practice Address - Phone:406-759-5194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4611208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0016014Medicaid
MT0720273Medicaid
MTCH5893Medicare ID - Type UnspecifiedGROUP MEDICARE RAILROAD
MT273994Medicare ID - Type UnspecifiedALL PROVIDER NUMBER
MT0720273Medicaid