Healthcare Provider Details

I. General information

NPI: 1972573640
Provider Name (Legal Business Name): SUSAN YOUNG DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E BASELINE RD
TEMPE AZ
85283-1511
US

IV. Provider business mailing address

1920 E BASELINE RD
TEMPE AZ
85283-1511
US

V. Phone/Fax

Practice location:
  • Phone: 480-345-5000
  • Fax:
Mailing address:
  • Phone: 480-345-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0435
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: