Provider Demographics
NPI:1871557355
Name:YOUNGBERG, LINDA KAY (DO)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KAY
Last Name:YOUNGBERG
Suffix:
Gender:F
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:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-0326
Mailing Address - Country:US
Mailing Address - Phone:918-256-7551
Mailing Address - Fax:918-256-3703
Practice Address - Street 1:735 N FOREMAN ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-1422
Practice Address - Country:US
Practice Address - Phone:918-256-7551
Practice Address - Fax:918-256-3703
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2410207Q00000X
MOR5H41207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200355260AMedicaid
431704371OtherTAX ID FOR FREEMAN
MO243419306Medicaid
C94613Medicare UPIN
KS200355260AMedicaid