Healthcare Provider Details

I. General information

NPI: 1649336611
Provider Name (Legal Business Name): RUSH ALEXANDER YOUNGBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9381 NE NORTH SHORE RD
BELFAIR WA
98528-8700
US

IV. Provider business mailing address

9381 NE NORTH SHORE RD
BELFAIR WA
98528-8700
US

V. Phone/Fax

Practice location:
  • Phone: 360-277-4171
  • Fax: 360-277-4135
Mailing address:
  • Phone: 360-277-4171
  • Fax: 360-277-4135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD000012985
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: