Provider Demographics
NPI:1841258217
Name:BETHEA, LOUISE H (MD)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:H
Last Name:BETHEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:H
Other - Last Name:BETHEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:25250 BOROUGH PARK DR
Mailing Address - Street 2:109
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3565
Mailing Address - Country:US
Mailing Address - Phone:281-298-8132
Mailing Address - Fax:281-298-8213
Practice Address - Street 1:25250 BOROUGH PARK DR
Practice Address - Street 2:109
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3565
Practice Address - Country:US
Practice Address - Phone:281-298-8132
Practice Address - Fax:281-298-8213
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7699207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX853280OtherBCBS
C13432Medicare UPIN
TX8007M1Medicare ID - Type Unspecified