Individual
MR. ROBERT R YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
12 E MACARTHUR ST, SHAWNEE, OK 74804-2135
(405) 275-1001
(405) 275-1201
Mailing address
12605 OOLA CT, CHOCTAW, OK 73020-2039
(719) 440-0037
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1245
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52486265
—
CO
01
—
970014182
RR MEDICARE
CO
Enumeration date
05/10/2006
Last updated
03/04/2025
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