Provider Demographics
NPI:1417953381
Name:YOUNG, MARTIN KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:KENNETH
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 DOCTORS PARK DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8127
Mailing Address - Country:US
Mailing Address - Phone:541-779-1300
Mailing Address - Fax:541-779-9171
Practice Address - Street 1:2940 DOCTORS PARK DR
Practice Address - Street 2:CHILDREN AND ADOLESCENTS CLINIC
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-779-1300
Practice Address - Fax:541-779-9171
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22188208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR138148Medicaid
ORH11323Medicare UPIN
ORR134915Medicare PIN