Provider Demographics
NPI:1063428951
Name:YOUNG, JEFFREY WILLIAM (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19220 MCLOUGHLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2642
Mailing Address - Country:US
Mailing Address - Phone:503-656-4268
Mailing Address - Fax:503-655-4189
Practice Address - Street 1:19220 MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2642
Practice Address - Country:US
Practice Address - Phone:503-656-4268
Practice Address - Fax:503-655-4189
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO21904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287601Medicaid
ORH383-57Medicare UPIN
OR287601Medicaid