Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 8769 | AZ |
NPI | 1003995895 |
---|---|
Provider Name | Dr. Elaine P Young |
First Address | Cottonwood, AZ 86326-4160 |
Second Address | Cottonwood, AZ 86326-4160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 30/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D67061 | (02) |