Provider Demographics
NPI:1790777662
Name:YOUNG, ROBERT ELLSWORTH II (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELLSWORTH
Last Name:YOUNG
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:100 MISSION BLVD
Practice Address - Street 2:SUITE 2800
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2536
Practice Address - Country:US
Practice Address - Phone:209-257-0177
Practice Address - Fax:209-257-0176
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2015-06-29
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Provider Licenses
StateLicense IDTaxonomies
CAG86327207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G863270Medicaid
ZZZ275702Medicare ID - Type Unspecified
CA00G863270Medicaid
B09948Medicare UPIN