Provider Demographics
NPI:1497736599
Name:YOUNG, JEFFREY MILTON (PA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MILTON
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 S WINDSOR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-3814
Mailing Address - Country:US
Mailing Address - Phone:480-610-9794
Mailing Address - Fax:
Practice Address - Street 1:13677 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2618
Practice Address - Country:US
Practice Address - Phone:623-882-1500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2072207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0728670OtherBLUE CROSS BLUE SHIELD GR
AZAW1436OtherHEALTHNET GROUP NUMBER
AZ3981220OtherEVERCARE GROUP NUMBER
S41506Medicare UPIN
AZ3981220OtherEVERCARE GROUP NUMBER