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General NPI Number Information
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NPI Number | 1730139015
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Entity Type | Individual
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Provider Name | ROBERT R YOUNG PA
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 12 E MACARTHUR ST
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City | SHAWNEE
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State | OK
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Zip | 74804-2135
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Country | US
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Telephone | 405-275-1001
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Fax | 405-275-1201
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Provider Business Mailing Address
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Address Line | 12605 OOLA CT
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City | CHOCTAW
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State | OK
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Zip | 73020-2039
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Country | US
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Telephone | 719-440-0037
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1245
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License Number State | CO
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