Individual
BRIAN YOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
347 MAIN ST., GORHAM, ME 04038
(207) 839-2521
Mailing address
39 WALLACE AVE, SO. PORTLAND, ME 04106
(207) 761-0650
(207) 761-8198
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
014237
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
335100099
—
ME
Enumeration date
10/03/2006
Last updated
07/08/2007
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