Healthcare Provider Details

I. General information

NPI: 1093790834
Provider Name (Legal Business Name): MARK R. YOUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S 48TH ST STE 610
LINCOLN NE
68506-1200
US

IV. Provider business mailing address

1500 S 48TH ST STE 610
LINCOLN NE
68506-1200
US

V. Phone/Fax

Practice location:
  • Phone: 402-493-3712
  • Fax: 402-493-8341
Mailing address:
  • Phone: 402-493-3712
  • Fax: 402-493-8341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number21253
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: