Healthcare Provider Details

I. General information

NPI: 1821593351
Provider Name (Legal Business Name): PHILIP RYAN YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4265
US

IV. Provider business mailing address

1215 LEE ST BOX 800744
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 253-596-3300
  • Fax: 253-596-3301
Mailing address:
  • Phone: 434-924-1931
  • Fax: 434-243-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD61532898
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: