Healthcare Provider Details

I. General information

NPI: 1427499367
Provider Name (Legal Business Name): ELIZABETH BISH YOUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BELLWOOD LN
ROSEBURG OR
97471-9299
US

IV. Provider business mailing address

901 BELLWOOD LN
ROSEBURG OR
97471-9299
US

V. Phone/Fax

Practice location:
  • Phone: 541-580-0345
  • Fax:
Mailing address:
  • Phone: 541-580-0345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD08066
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: