Healthcare Provider Details

I. General information

NPI: 1740712660
Provider Name (Legal Business Name): SUSAN B. YOUNG DO PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 W URBANA ST
BROKEN ARROW OK
74012-5504
US

IV. Provider business mailing address

PO BOX 21052 DEPT 22431
TULSA OK
74121-1052
US

V. Phone/Fax

Practice location:
  • Phone: 918-290-2300
  • Fax: 918-290-2310
Mailing address:
  • Phone: 405-775-9350
  • Fax: 405-775-9360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3799
License Number StateOK

VIII. Authorized Official

Name: SUSAN YOUNG
Title or Position: OWNER
Credential: D.O.
Phone: 405-775-9350