Provider Demographics
NPI:1942312616
Name:CHOUDRY, YASIN M (MD)
Entity Type:Individual
Prefix:
First Name:YASIN
Middle Name:M
Last Name:CHOUDRY
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 1:933 BRADBURY DR SE
Mailing Address - Street 2:STE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4375
Mailing Address - Country:US
Mailing Address - Phone:352-638-5534
Mailing Address - Fax:
Practice Address - Street 1:2400 TUCKER NE
Practice Address - Street 2:FAMILY MEDICINE CENTER, 4TH FLOOR
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:352-638-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2015-06652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLXC9988683OtherSUBOXONE #
FLME96757OtherFL LIC
NMMD2015-0665OtherLICENSE
NMMD2015-0665OtherLICENSE
FL276391500Medicaid