Healthcare Provider Details

I. General information

NPI: 1104980663
Provider Name (Legal Business Name): MAURICE EDGAR YOUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9897 W MCDOWELL RD STE 101
TOLLESON AZ
85353-1621
US

IV. Provider business mailing address

8866 W HILTON AVE
TOLLESON AZ
85353-6969
US

V. Phone/Fax

Practice location:
  • Phone: 623-474-2300
  • Fax:
Mailing address:
  • Phone: 480-798-3225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101237702
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC55463
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101237702
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01060075A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number51391
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: