Provider Demographics
NPI:1245310598
Name:YUDOFSKY, STUART (MD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:YUDOFSKY
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 1:1977 BUTLER BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4101
Mailing Address - Country:US
Mailing Address - Phone:713-798-4945
Mailing Address - Fax:713-796-9718
Practice Address - Street 1:1977 BUTLER BLVD
Practice Address - Street 2:STE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4101
Practice Address - Country:US
Practice Address - Phone:713-798-4945
Practice Address - Fax:713-796-9718
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD73762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119232001Medicaid
TXTXB121801Medicare PIN
TX119232001Medicaid
TX88M052Medicare PIN