MEDICARE: MITCHELL YOUNT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	L2766	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790788115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL YOUNT MD

Provider Business Mailing Address
First Line	:	815 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2224
Country	:	US
Telephone Number	:	817-321-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2224
Country	:	US
Telephone Number	:	817-321-0387
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	10/02/2018

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Directions to “ MITCHELL YOUNT MD” Practice Location

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