Healthcare Provider Details

I. General information

NPI: 1013942861
Provider Name (Legal Business Name): PERMIAN WOMEN'S CENTER, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N TOM GREEN AVE
ODESSA TX
79761-5145
US

IV. Provider business mailing address

405 N TOM GREEN AVE
ODESSA TX
79761-5145
US

V. Phone/Fax

Practice location:
  • Phone: 432-580-9876
  • Fax:
Mailing address:
  • Phone: 432-580-9876
  • Fax: 432-580-9877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK2522
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberK2565
License Number StateTX

VIII. Authorized Official

Name: MR. PILL G. RAJA
Title or Position: CEO
Credential: M.D.
Phone: 432-580-9876