MEDICARE: RAJA NAIDU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	K1267	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124095161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJA NAIDU MD

Provider Business Mailing Address
First Line	:	605 E 4TH ST
Second Line	:	SUITE 203
City	:	ODESSA
State	:	TX
Zip	:	79761-5100
Country	:	US
Telephone Number	:	432-617-8329
Fax Number	:	432-339-8454

Provider Business Practice Location Address
First Line	:	605 E 4TH ST
Second Line	:	SUITE 203
City	:	ODESSA
State	:	TX
Zip	:	79761-5100
Country	:	US
Telephone Number	:	432-617-8329
Fax Number	:	432-339-8454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	09/16/2011

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Directions to “ RAJA NAIDU MD” Practice Location

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