Provider Demographics
NPI:1295979631
Name:YOUNG, CHARLES NATHAN (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:NATHAN
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 1:2630 W CROWN KING DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2568
Mailing Address - Country:US
Mailing Address - Phone:520-742-8750
Mailing Address - Fax:
Practice Address - Street 1:2630 W CROWN KING DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2568
Practice Address - Country:US
Practice Address - Phone:520-742-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27890207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine