Individual
DR. SAJJUDAL ISLAM SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
320 N MUSKINGUM AVE, ODESSA, TX 79761-5152
(432) 335-8400
(432) 335-5805
Mailing address
320 N MUSKINGUM AVE, ODESSA, TX 79761-5152
(432) 335-8400
(432) 335-5805
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
G7240
TX
2085R0202X
Diagnostic Radiology Physician
Primary
G7240
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00GE62
BLUE CROSS OF TEXAS
TX
05
—
120388704
—
TX
01
—
G7240
WORK COMP
TX
Enumeration date
08/10/2005
Last updated
04/30/2012
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