Provider Demographics
NPI:1124095161
Name:NAIDU, RAJA (MD)
Entity type:Individual
Prefix:
First Name:RAJA
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 203
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5100
Mailing Address - Country:US
Mailing Address - Phone:432-617-8329
Mailing Address - Fax:432-339-8454
Practice Address - Street 1:605 E 4TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5100
Practice Address - Country:US
Practice Address - Phone:432-617-8329
Practice Address - Fax:432-339-8454
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1267207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151043001Medicaid
TX8692J2Medicare PIN
TX151043001Medicaid