Provider Demographics
NPI:1629170345
Name:YOUNG, MARK SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SCOTT
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 770805
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38177-0805
Mailing Address - Country:US
Mailing Address - Phone:901-844-2500
Mailing Address - Fax:901-844-1439
Practice Address - Street 1:5959 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5200
Practice Address - Country:US
Practice Address - Phone:901-844-2500
Practice Address - Fax:901-844-1439
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000016172207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2682946OtherCIGNA
TNP00026724OtherRAILROAD MEDICARE
TN757994OtherUNITED HEALTH CARE
TN4064280OtherBLUE CROSS
TN4060623OtherAETNA
TN2682946OtherCIGNA
TN4060623OtherAETNA