Active NPI
Lawrence Raymond Ydens, MD
- Anesthesiology Physician
- Albuquerque, NM
National Provider Identifier
1790791028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 85-312
- Practice address
- 4401 Masthead St NE # 120
Albuquerque, NM 87109-4327 - Phone
- (505) 243-7729
- Fax
- (505) 243-4804
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 85-312 | NM | Primary |
Addresses
Primary practice location
4401 Masthead St NE # 120
Albuquerque, NM 87109-4327
Mailing address
4401 Masthead St NE # 120
Albuquerque, NM 87109-4327
Phone (505) 243-7729
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 35998 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 85-312 | NM | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1790791028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4401 MASTHEAD ST NE # 120",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871094327",
"telephone_number": "505-243-7729",
"fax_number": "505-243-4804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4401 MASTHEAD ST NE # 120",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871094327",
"telephone_number": "505-243-7729",
"fax_number": "505-243-4804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YDENS",
"first_name": "LAWRENCE",
"middle_name": "RAYMOND",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NM",
"license": "85-312",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "35998",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.