Basic Information
Provider Information
NPI: 1376706911
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MUNSON-YOUNG
FirstName: ADAM
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5157
Address2:  
City: VANCOUVER
State: WA
PostalCode: 986685157
CountryCode: US
TelephoneNumber: 3608285396
FaxNumber: 3608285455
Practice Location
Address1: 505 NE 87TH AVE
Address2: SUITE 46.5
City: VANCOUVER
State: WA
PostalCode: 986641989
CountryCode: US
TelephoneNumber: 3608285396
FaxNumber: 3608285455
Other Information
ProviderEnumerationDate: 07/03/2008
LastUpdateDate: 12/03/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000XMT190157PAN Student, Health CareStudent in an Organized Health Care Education/Training Program 
207L00000XMD60206234WAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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