Provider Demographics
NPI:1679593859
Name:YOUNG, ROY TALBOT (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:TALBOT
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67780 E PALM CANYON DR
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-5441
Mailing Address - Country:US
Mailing Address - Phone:760-837-8993
Mailing Address - Fax:760-837-8994
Practice Address - Street 1:67780 E PALM CANYON DR
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-5441
Practice Address - Country:US
Practice Address - Phone:760-837-8993
Practice Address - Fax:760-837-8994
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90484Medicare UPIN
CAWG17208AMedicare PIN
CAWG17208AMedicare PIN