1003143942 NPI number — ROBERT L. YOUNGBLOOD, M.D.,P.C.

Table of content: (NPI 1003143942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003143942 NPI number — ROBERT L. YOUNGBLOOD, M.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT L. YOUNGBLOOD, M.D.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003143942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
880 E 9400 S
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84094-3667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-571-4007
Provider Business Mailing Address Fax Number:
801-571-4145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 E 9400 S
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
SANDY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84094-3667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-571-4007
Provider Business Practice Location Address Fax Number:
801-571-4145
Provider Enumeration Date:
11/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNGBLOOD
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
801-571-4007

Provider Taxonomy Codes

  • Taxonomy code: 2082S0099X , with the licence number:  150842-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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