Provider Demographics
NPI:1407911498
Name:YOUNG, JEFFREY S (MD/FAMILY PRACTICE)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:S
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD/FAMILY PRACTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:100 E 33RD ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2776
Mailing Address - Country:US
Mailing Address - Phone:360-695-1334
Mailing Address - Fax:360-992-1159
Practice Address - Street 1:100 E 33RD ST
Practice Address - Street 2:SUITE 206
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2776
Practice Address - Country:US
Practice Address - Phone:360-695-1334
Practice Address - Fax:360-992-1159
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00030234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1407911498Medicaid
F63514Medicare UPIN
WA1407911498Medicaid