Healthcare Provider Details

I. General information

NPI: 1851312268
Provider Name (Legal Business Name): JAYANTA CHOUDHURY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 N CHESTNUT AVE SUITE 101
FRESNO CA
93720-0349
US

IV. Provider business mailing address

2823 FRESNO ST COMMUNITY REGIONAL MEDICAL,1ST FLOOR ENDOSCOPY SUITE
FRESNO CA
93721-1324
US

V. Phone/Fax

Practice location:
  • Phone: 559-326-1010
  • Fax: 559-326-1020
Mailing address:
  • Phone: 559-459-3882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA98988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: