Provider Demographics
NPI:1013900059
Name:YOUNG, DONALD ANDREW III (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ANDREW
Last Name:YOUNG
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:SUITE 514
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2991
Practice Address - Country:US
Practice Address - Phone:503-488-2323
Practice Address - Fax:503-488-2340
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD06578208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8199366Medicaid
OR220475Medicaid
OR220475Medicaid
OR143444Medicare PIN
OR034WDBBFDMedicare ID - Type Unspecified