Provider Demographics
NPI:1184779456
Name:ROHDE, PENNYE M (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:PENNYE
Middle Name:M
Last Name:ROHDE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 LAMONTE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-4319
Mailing Address - Country:US
Mailing Address - Phone:832-483-4158
Mailing Address - Fax:713-778-0827
Practice Address - Street 1:2620 E CROSSTIMBERS ST STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-8629
Practice Address - Country:US
Practice Address - Phone:713-486-8550
Practice Address - Fax:713-692-2500
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA02313OtherLICENCE