Provider Demographics
NPI:1114965233
Name:PETHE, RAJEEV S (MD)
Entity Type:Individual
Prefix:
First Name:RAJEEV
Middle Name:S
Last Name:PETHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TWILIGHT GLEN CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4826
Mailing Address - Country:US
Mailing Address - Phone:936-266-3943
Mailing Address - Fax:360-323-5965
Practice Address - Street 1:30 TWILIGHT GLEN CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77381-4826
Practice Address - Country:US
Practice Address - Phone:936-266-3943
Practice Address - Fax:360-323-5965
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0995207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122187115OtherCSHCN
TX8B8769OtherBCBSTX
TX8M3087OtherBCBS
TX122187110Medicaid
TX8M7297OtherBCBS
TX122187107Medicaid
TX1114965233Medicaid
TX8B8769OtherBCBSTX
TX8M7297OtherBCBS
TX8M3087OtherBCBS
TX8B7195Medicare PIN
TX8A6437Medicare PIN
TXG35614Medicare UPIN
TX8F1200Medicare PIN