Healthcare Provider Details

I. General information

NPI: 1376706911
Provider Name (Legal Business Name): ADAM J MUNSON-YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE SUITE 46.5
VANCOUVER WA
98664-1989
US

IV. Provider business mailing address

PO BOX 5157
VANCOUVER WA
98668-5157
US

V. Phone/Fax

Practice location:
  • Phone: 360-828-5396
  • Fax: 360-828-5455
Mailing address:
  • Phone: 360-828-5396
  • Fax: 360-828-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT190157
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD60206234
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: