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Individual

GERALD L YOUNG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
366 S 3RD W, SODA SPRINGS, ID 83276-1559
(208) 547-4961
(208) 547-3781
Mailing address
366 S 3RD W, SODA SPRINGS, ID 83276-1559
(208) 547-4961
(208) 547-3781

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M3234
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010006157
REGENCE BLUE SHIELD
ID
05
0025019
ID
01
080191334
RAILROAD MEDICARE
ID
01
32342
BLUE CROSS OF IDAHO
ID
Enumeration date
08/08/2006
Last updated
03/25/2010
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