Provider Demographics
NPI:1851312268
Name:CHOUDHURY, JAYANTA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYANTA
Middle Name:
Last Name:CHOUDHURY
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 1:2823 FRESNO ST
Mailing Address - Street 2:COMMUNITY REGIONAL MEDICAL,1ST FLOOR ENDOSCOPY SUITE
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1324
Mailing Address - Country:US
Mailing Address - Phone:559-459-3882
Mailing Address - Fax:
Practice Address - Street 1:7015 N CHESTNUT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0349
Practice Address - Country:US
Practice Address - Phone:559-326-1010
Practice Address - Fax:559-326-1020
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98988207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology