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Individual

DR. PREMALATHA VINDHYA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2479 E 11TH ST, ODESSA, TX 79761-4232
(432) 333-1901
(432) 520-5914
Mailing address
2101 N MIDLAND DR, STE 9, MIDLAND, TX 79707-5593
(432) 699-0255
(432) 520-5914

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G7739
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00G812
BLUE CROSS
TX
05
033527501
TX
01
070006346
RAILROAD MEDICARE
TX
01
126180100
FIRST CARE
TX
01
45 21 529
AETNA
TX
01
72145673
WAUSAU
TX
01
820060
CENTRAL STATES SOUTHEAST
TX
01
G7739
STATE LICENSE
TX
01
N59U
STATE FARM
TX
Enumeration date
05/20/2006
Last updated
07/12/2016
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