Provider Demographics
NPI:1891711677
Name:PESCH, THEODOR (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:THEODOR
Middle Name:
Last Name:PESCH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 E ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-5366
Mailing Address - Country:US
Mailing Address - Phone:956-346-4134
Mailing Address - Fax:
Practice Address - Street 1:507 E ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520
Practice Address - Country:US
Practice Address - Phone:956-346-4134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420172207P00000X
TXM0863207P00000X, 207P00000X
VA0101244999207P00000X
NC2009-00214207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00443289Medicare PIN
TX8J8185Medicare PIN
TX8J9003Medicare PIN
TXP00443036Medicare PIN
TXH13362Medicare UPIN