Provider Demographics
NPI:1124026836
Name:YOUNG, MICHAEL CLARENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLARENCE
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 1:301 HALE AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71857-3330
Mailing Address - Country:US
Mailing Address - Phone:870-887-6651
Mailing Address - Fax:870-887-2008
Practice Address - Street 1:301 HALE AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AR
Practice Address - Zip Code:71857-3330
Practice Address - Country:US
Practice Address - Phone:870-887-6651
Practice Address - Fax:870-887-2008
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2009-10-08
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
ARC4873207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127720000OtherQUAL CHOICE
AR080043829OtherGBA RAILROAD
AR1124026836Medicaid
ARD83905Medicare UPIN
AR080043829OtherGBA RAILROAD