Individual
ANJAIAH KODITYAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 E 6TH ST, SUITE 205, ODESSA, TX 79761-4529
(432) 337-0555
(432) 337-0558
Mailing address
420 E 6TH ST, SUITE 205, ODESSA, TX 79761-4529
(432) 337-0555
(432) 337-0558
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
H8708
TX
207RP1001X
Pulmonary Disease Physician
Primary
H8708
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116990100
FIRST CARE
—
05
—
131791905
—
TX
01
—
290005045
RAILROAD MEDICARE
—
01
—
5241453
AETNA
TX
01
—
OOJ89Z
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/05/2006
Last updated
12/10/2013
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