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Individual
VIJAYA NAMA
Active
Individual
VIJAYA NAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036098837
IL
207Q00000X
Family Medicine Physician
Primary
L7821
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0072NK
BLUE SHIELD
TX
05
—
036098837
—
IL
05
—
171109502
—
TX
Enumeration date
11/21/2005
Last updated
01/25/2012
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