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General NPI Number Information
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NPI Number | 1336423169
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Entity Type | Organization
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Legal Business Name | RAJA NAIDU MD PA
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 605 E. 4TH ST SUITE 203
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City | ODESSA
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State | TX
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Zip | 79761-5100
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Country | US
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Telephone | 432-617-8329
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Fax | 432-339-8454
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Provider Business Mailing Address
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Address Line | 605 E. 4TH ST SUITE 203
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City | ODESSA
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State | TX
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Zip | 79761-5100
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Country | US
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Telephone | 432-617-8329
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Fax | 432-339-8454
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Authorized Official
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Title or Position | MD
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Name | RAJA NAIDU
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Credential |
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Telephone | 432-617-8329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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