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General NPI Number Information
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NPI Number | 1770770638
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Entity Type | Organization
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Legal Business Name | VIJAYA NAMA M.D PA
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 5115 N GALLOWAY AVE STE 304
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City | MESQUITE
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State | TX
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Zip | 75150-7535
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Country | US
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Telephone | 972-613-2127
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Fax | 972-613-2726
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Provider Business Mailing Address
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Address Line | PO BOX 851484
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City | MESQUITE
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State | TX
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Zip | 75185-1484
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Country | US
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Telephone | 972-613-2127
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Fax | 972-613-2726
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. VIJAYA NAMA
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Credential | M.D
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Telephone | 972-613-2127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L7821
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License Number State | TX
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