Provider Demographics
NPI:1861633265
Name:GOLUBEV, IURI STANISLAV (MD)
Entity type:Individual
Prefix:DR
First Name:IURI
Middle Name:STANISLAV
Last Name:GOLUBEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4411 THE 25 WAY NE STE 325
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5853
Mailing Address - Country:US
Mailing Address - Phone:505-823-4411
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:4411 THE 25 WAY NE STE 325
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5853
Practice Address - Country:US
Practice Address - Phone:505-823-4411
Practice Address - Fax:505-343-6085
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2014-0885207W00000X
NY305661207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2014-0885OtherLICENCE NUMBER
NM54688370Medicaid