Provider Demographics
NPI:1801819164
Name:NARRA, KOTESWARAMMA (MD)
Entity Type:Individual
Prefix:DR
First Name:KOTESWARAMMA
Middle Name:
Last Name:NARRA
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 1:3508 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1316
Mailing Address - Country:US
Mailing Address - Phone:806-799-2093
Mailing Address - Fax:806-799-8132
Practice Address - Street 1:3508 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1316
Practice Address - Country:US
Practice Address - Phone:806-799-2093
Practice Address - Fax:806-799-8132
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0145207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE67969Medicare UPIN
TX8B8376Medicare ID - Type Unspecified