Healthcare Provider Details

I. General information

NPI: 1033208731
Provider Name (Legal Business Name): LINDA YOUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA YOUNG SHUMATE MD

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SOUTH HOLLY STREET
MEDFORD OR
97501
US

IV. Provider business mailing address

3857 MARTIN WAY E
OLYMPIA WA
98506-5268
US

V. Phone/Fax

Practice location:
  • Phone: 541-774-8200
  • Fax: 541-774-7964
Mailing address:
  • Phone: 360-704-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberC-7772
License Number StateAR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier260020819
Identifier TypeOTHER
Identifier StateAR
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier52902
Identifier TypeOTHER
Identifier StateAR
Identifier IssuerBCBS
# 3
Identifier125671001
Identifier TypeMEDICAID
Identifier StateAR
Identifier Issuer
# 4
IdentifierC7772
Identifier TypeOTHER
Identifier StateAR
Identifier IssuerTRICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: