Provider Demographics
NPI:1093790834
Name:YOUNG, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1500 S 48TH ST STE 610
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1200
Mailing Address - Country:US
Mailing Address - Phone:402-493-3712
Mailing Address - Fax:402-493-8341
Practice Address - Street 1:1500 S 48TH ST STE 610
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1200
Practice Address - Country:US
Practice Address - Phone:402-493-3712
Practice Address - Fax:402-493-8341
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE21253207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1103OtherBCBS
NE47082854000Medicaid
NE272531Medicare PIN
G04000Medicare UPIN