Individual
ROGER YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1250 W WHITTAKER ST, SALEM, IL 62881-1917
(618) 548-3740
(618) 548-3705
Mailing address
1250 W WHITTAKER ST, SALEM, IL 62881-1917
(618) 548-3740
(618) 548-3705
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
041255812
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110230526
RAILROAD MEDICARE
IL
01
—
207988
GRP MEDICARE NUMBER
IL
01
—
208959
GRP MEDICARE NUMBER
IL
01
—
500025714
RAILROAD MEDICARE NUMBER
IL
01
—
CJ2166
RR MEDICARE GROUP NUMBER
IL
Enumeration date
10/07/2005
Last updated
10/16/2013
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