Provider Demographics
NPI:1679624225
Name:YOUNGBLOOD, ROBERT LEE I (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:YOUNGBLOOD
Suffix:I
Gender:M
Credentials:MD
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Mailing Address - Street 1:880 E 9400 S
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3667
Mailing Address - Country:US
Mailing Address - Phone:801-571-4007
Mailing Address - Fax:801-571-4145
Practice Address - Street 1:880 E 9400 S
Practice Address - Street 2:SUITE 111
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3667
Practice Address - Country:US
Practice Address - Phone:801-571-4007
Practice Address - Fax:801-571-4145
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
UT150842-1205208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery