Provider Demographics
NPI:1538255443
Name:YOUNG, JOHN RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RUSSELL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2120 W ELK AVE RM 5
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1576
Mailing Address - Country:US
Mailing Address - Phone:580-255-9797
Mailing Address - Fax:580-255-9826
Practice Address - Street 1:2120 W ELK AVE RM 5
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1576
Practice Address - Country:US
Practice Address - Phone:580-255-9797
Practice Address - Fax:580-255-9826
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK17503207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD24654Medicare UPIN