Healthcare Provider Details

I. General information

NPI: 1326087941
Provider Name (Legal Business Name): MARTIN C YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 BETIN AVE
MONROE LA
71201-7257
US

IV. Provider business mailing address

2913 BETIN AVE
MONROE LA
71201-7257
US

V. Phone/Fax

Practice location:
  • Phone: 318-561-9945
  • Fax:
Mailing address:
  • Phone: 318-651-9945
  • Fax: 318-410-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMD09436R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number09436R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: