Provider Demographics
NPI:1043213721
Name:YOUNG KNOLLE, SUE E (MD)
Entity type:Individual
Prefix:DR
First Name:SUE
Middle Name:E
Last Name:YOUNG KNOLLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S CAPITAL OF TEXAS HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4305
Mailing Address - Country:US
Mailing Address - Phone:512-472-4011
Mailing Address - Fax:512-472-5057
Practice Address - Street 1:515 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:STE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4305
Practice Address - Country:US
Practice Address - Phone:512-472-4011
Practice Address - Fax:512-472-5057
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-11-06
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
TXD6220207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZOOOL63V8MedicaidMEDICAID NUMBER
TX1043213721OtherNPI
TX1154432508OtherGROUP NPI
TX1154432508OtherGROUP NPI
TXC23880Medicare UPINMEDICARE UPIN NUMBER