MEDICARE: ROBERT YOUNG MD

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	261QH0100X	Health Service Clinic/Center	C-5255	AR

General Provider Information

NPI Number	:	1952794828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT YOUNG MD

Provider Business Mailing Address
First Line	:	4617 CRESTWOOD DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207
Country	:	US
Telephone Number	:	501-680-1176
Fax Number	:

Provider Business Practice Location Address
First Line	:	4617 CRESTWOOD DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207
Country	:	US
Telephone Number	:	501-680-1176
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT P YOUNG
Credential	:	MD
Telephone Number	:	501-680-1176

Provider Enumeration Date	:	03/16/2015
Last Update Date	:	03/16/2015

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