Provider Demographics
NPI:1821000431
Name:YOUNG, SCOTT J (PA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:13166 N 154TH LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-9157
Mailing Address - Country:US
Mailing Address - Phone:623-251-5617
Mailing Address - Fax:
Practice Address - Street 1:19841 N 27TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4005
Practice Address - Country:US
Practice Address - Phone:623-582-6420
Practice Address - Fax:623-582-6720
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3501363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ157621Medicaid
Q03102Medicare UPIN
AZ157621Medicaid