Provider Demographics
NPI:1730306663
Name:CHOUDHRY, JO LANEE (MD)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:LANEE
Last Name:CHOUDHRY
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 1:16040 PARK VALLEY DR
Mailing Address - Street 2:SUITE 222
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3578
Mailing Address - Country:US
Mailing Address - Phone:512-341-8001
Mailing Address - Fax:512-341-8190
Practice Address - Street 1:16040 PARK VALLEY DR
Practice Address - Street 2:SUITE 222
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3578
Practice Address - Country:US
Practice Address - Phone:512-341-8001
Practice Address - Fax:512-341-8190
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8601207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197775301Medicaid
TXM8601OtherTEXAS LICENSE
TX8F9000Medicare PIN