Gerald L Young, M.D.
Individual provider Active NPI Family Medicine Physician · Soda Springs, ID
NPI 1649280256 · NPPES record last updated Mar 25, 2010
Key facts
- NPI
- 1649280256
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- M3234 (ID)
- Practice address
- 366 S 3Rd W
Soda Springs, ID 83276-1559 - Phone
- (208) 547-4961
- Fax
- (208) 547-3781
- NPI assigned
- Aug 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M3234 | ID | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M3234 | ID | Yes |
Addresses
Primary practice location
366 S 3Rd W
Soda Springs, ID 83276-1559
Mailing address
366 S 3Rd W
Soda Springs, ID 83276-1559
Phone (208) 547-4961
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0025019 | Medicaid | ID | |
| 080191334 | Other | ID | RAILROAD MEDICARE |
| 000010006157 | Other | ID | REGENCE BLUE SHIELD |
| 32342 | Other | ID | BLUE CROSS OF IDAHO |
Other providers in Soda Springs, ID
All providers in Soda Springs, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.