Provider Demographics
NPI:1730139015
Name:YOUNG, ROBERT R (PA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-364-0555
Mailing Address - Fax:405-573-5483
Practice Address - Street 1:700 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6232
Practice Address - Country:US
Practice Address - Phone:405-364-0555
Practice Address - Fax:405-573-5483
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-07-08
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Provider Licenses
StateLicense IDTaxonomies
CO1245363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52486265Medicaid
CO970014182OtherRR MEDICARE
COCOA103395Medicare PIN
CO52486265Medicaid
COCX0538Medicare PIN