Samrajyam Kolluru, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

H9663 Issued in TX

Practice address

621 N Washington Ave
Odessa, TX 79761-4436

Phone

(432) 580-9999

Fax

(432) 580-5051

NPI assigned

Jul 6, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770580631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 SANTA MARIA CT",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797658515",
            "telephone_number": "432-272-5852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 N WASHINGTON AVE",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797614436",
            "telephone_number": "432-580-9999",
            "fax_number": "432-580-5051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLURU",
        "first_name": "SAMRAJYAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "H9663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Elizabeth Kizer, M.S.CCC.SLP
• Lance Kneese, PHARMD
• Anjaiah Kodityal, MD
• Meera Kodityal, MD
• Ramachandra Kolluru, MD
• Samata Kona
• Christian Korner, PTA
• Ewa Korzeniowska, CRNA
• Joni Kouba
• Katie L Koym, OTR

• Specialist in Odessa, TX
• Providers in Odessa, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.