Provider Demographics
NPI:1376734731
Name:YOUNGBLOOD, MARY KATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHERINE
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3120
Mailing Address - Country:US
Mailing Address - Phone:727-584-7706
Mailing Address - Fax:727-582-9323
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-3120
Practice Address - Country:US
Practice Address - Phone:859-323-6700
Practice Address - Fax:859-257-1331
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63721207RR0500X
KYTP312207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23324OtherBCBS
FL1000649OtherCAREPLUS
FL4355089OtherAETNA
FL373864700Medicaid
FL373864700Medicaid
FL4355089OtherAETNA