Provider Demographics
NPI:1447415427
Name:YOUNG, MARY ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4730 E INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5441
Mailing Address - Country:US
Mailing Address - Phone:602-354-3491
Mailing Address - Fax:602-595-8567
Practice Address - Street 1:4730 E INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 211
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5441
Practice Address - Country:US
Practice Address - Phone:602-354-3491
Practice Address - Fax:602-595-8567
Is Sole Proprietor?:No
Enumeration Date:2008-07-19
Last Update Date:2008-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005049207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine