Provider Demographics
NPI:1467430496
Name:YOUNG, SUSAN BLYTHE (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BLYTHE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:B
Other - Last Name:FINDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1831 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3922
Mailing Address - Country:US
Mailing Address - Phone:918-824-7773
Mailing Address - Fax:918-824-6410
Practice Address - Street 1:1301 NE 1ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-8850
Practice Address - Country:US
Practice Address - Phone:918-824-7767
Practice Address - Fax:918-824-6410
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3799208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200064490AMedicaid
OK242718301Medicare PIN
OK248534401Medicare ID - Type Unspecified
OK200064490AMedicaid