Basic Information
| Provider Information | |||||||||
| NPI: | 1578543856 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JACKSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 N MAGDALEN SQUARE | ||||||||
| Address2: | |||||||||
| City: | ABBEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3378934452 | ||||||||
| FaxNumber: | 3378937870 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 N MAGDALEN SQUARE | ||||||||
| Address2: | |||||||||
| City: | ABBEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3378934452 | ||||||||
| FaxNumber: | 3378937870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 13947 | LA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 1310697 | 05 | LA | MEDICAID |