Provider Demographics
NPI:1104980663
Name:YOUNG, MAURICE EDGAR (MD)
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:EDGAR
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5029 W NANCY LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-4248
Mailing Address - Country:US
Mailing Address - Phone:480-798-3225
Mailing Address - Fax:
Practice Address - Street 1:5130 W BASELINE RD STE 102
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2984
Practice Address - Country:US
Practice Address - Phone:602-237-7373
Practice Address - Fax:602-237-7977
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237702207V00000X, 2083A0100X, 208D00000X
AZ51391208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMC11305Medicare PIN