Provider Demographics
NPI:1003995895
Name:YOUNG, ELAINE P (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:P
Last Name:YOUNG
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Gender:F
Credentials:MD
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Mailing Address - Street 1:300 SOUTH WILLARD STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4160
Mailing Address - Country:US
Mailing Address - Phone:928-634-2192
Mailing Address - Fax:928-634-3825
Practice Address - Street 1:300 SOUTH WILLARD STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4160
Practice Address - Country:US
Practice Address - Phone:928-634-2192
Practice Address - Fax:928-634-3825
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-30
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Provider Licenses
StateLicense IDTaxonomies
AZ8769207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
860336614OtherEIN
D67061Medicare UPIN