MEDICARE: DR. JOHN RUSSELL YOUNG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	17503	OK

General Provider Information

NPI Number	:	1538255443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN RUSSELL YOUNG M.D.

Provider Business Mailing Address
First Line	:	2120 W ELK AVE RM 5
Second Line	:
City	:	DUNCAN
State	:	OK
Zip	:	73533-1576
Country	:	US
Telephone Number	:	580-255-9797
Fax Number	:	580-255-9826

Provider Business Practice Location Address
First Line	:	2120 W ELK AVE RM 5
Second Line	:
City	:	DUNCAN
State	:	OK
Zip	:	73533-1576
Country	:	US
Telephone Number	:	580-255-9797
Fax Number	:	580-255-9826

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JOHN RUSSELL YOUNG M.D.” Practice Location

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