Provider Demographics
NPI:1518904523
Name:YOUNG, SCOTT MACGREGOR (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MACGREGOR
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 1:9500 KANIS RD STE 310
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6339
Mailing Address - Country:US
Mailing Address - Phone:501-202-1500
Mailing Address - Fax:501-202-1357
Practice Address - Street 1:9500 KANIS RD STE 310
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6339
Practice Address - Country:US
Practice Address - Phone:501-202-1500
Practice Address - Fax:501-202-1357
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4210207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119293001Medicaid
ARR4210OtherARK LICENSE
AR119293001Medicaid
ARR4210OtherARK LICENSE