Provider Demographics
NPI:1487647012
Name:YOUNG, CRAIG M (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:24020 132ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5108
Mailing Address - Country:US
Mailing Address - Phone:253-631-2929
Mailing Address - Fax:253-631-2972
Practice Address - Street 1:24020 132ND AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-5108
Practice Address - Country:US
Practice Address - Phone:253-631-2929
Practice Address - Fax:253-631-2972
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA0019725207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1001718Medicaid
A05966Medicare UPIN