Provider Demographics
NPI:1386686558
Name:BORRA, RENUKA (MD)
Entity Type:Individual
Prefix:DR
First Name:RENUKA
Middle Name:
Last Name:BORRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:301 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5413
Practice Address - Country:US
Practice Address - Phone:432-355-8275
Practice Address - Fax:432-334-0687
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4257207RX0202X, 207RH0003X
NMMD2005-0299207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R1400OtherBLUE CROSS OF TEXAS
TX8940B9Medicare PIN
TX8R1400OtherBLUE CROSS OF TEXAS
H61025Medicare UPIN
TX8067B6Medicare PIN