MEDICARE: GARY W.O. YOUNG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G678890	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689601155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY W.O. YOUNG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 45680
Second Line	:	SUITE 7
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94145-0680
Country	:	US
Telephone Number	:	530-621-3600
Fax Number	:	530-626-7617

Provider Business Practice Location Address
First Line	:	4341 GOLDEN CENTER DR
Second Line	:	SUITE B
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-6260
Country	:	US
Telephone Number	:	530-621-3600
Fax Number	:	530-626-7617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	12/18/2013

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