Provider Demographics
NPI:1437147527
Name:YOUNGER, KENNETH M (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:YOUNGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:300 N WILLSON AVE
Mailing Address - Street 2:STE 1003
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3551
Mailing Address - Country:US
Mailing Address - Phone:406-587-1245
Mailing Address - Fax:406-587-1092
Practice Address - Street 1:300 N WILLSON AVE
Practice Address - Street 2:STE 1003
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3551
Practice Address - Country:US
Practice Address - Phone:406-587-1245
Practice Address - Fax:406-587-1092
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT3930207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0021944Medicaid
D90244Medicare UPIN
MT0021944Medicaid