Healthcare Provider Details

I. General information

NPI: 1124026836
Provider Name (Legal Business Name): MICHAEL CLARENCE YOUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/30/2006

III. Provider practice location address

301 HALE AVE
PRESCOTT AR
71857-3330
US

IV. Provider business mailing address

301 HALE AVE
PRESCOTT AR
71857-3330
US

V. Phone/Fax

Practice location:
  • Phone: 870-887-6651
  • Fax: 870-887-2008
Mailing address:
  • Phone: 870-887-6651
  • Fax: 870-887-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberC4873
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: