Provider Demographics
NPI:1972580066
Name:YOUNG, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1504 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-3702
Mailing Address - Country:US
Mailing Address - Phone:515-961-3700
Mailing Address - Fax:515-962-0160
Practice Address - Street 1:1504 N 1ST ST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-3702
Practice Address - Country:US
Practice Address - Phone:515-961-3700
Practice Address - Fax:515-962-0160
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA24278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2221515Medicaid
IA1221515Medicaid
IA0221515Medicaid
IA4221515Medicaid
IA4221515Medicaid
IA1221515Medicaid