Provider Demographics
NPI:1710954292
Name:NAIDU, JAYARAM (MD)
Entity Type:Individual
Prefix:
First Name:JAYARAM
Middle Name:
Last Name:NAIDU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E 4TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5100
Mailing Address - Country:US
Mailing Address - Phone:432-337-4347
Mailing Address - Fax:432-337-1657
Practice Address - Street 1:605 E 4TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5100
Practice Address - Country:US
Practice Address - Phone:432-337-4347
Practice Address - Fax:432-337-1657
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137326808Medicaid
TX82470FMedicare ID - Type Unspecified
TXB25076Medicare UPIN