Healthcare Provider Details

I. General information

NPI: 1114965233
Provider Name (Legal Business Name): RAJEEV S. PETHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 GRAND CENTRAL PKWY
CONROE TX
77304-3185
US

IV. Provider business mailing address

1169 GRAND CENTRAL PKWY
CONROE TX
77304-3185
US

V. Phone/Fax

Practice location:
  • Phone: 936-525-3600
  • Fax: 936-525-3624
Mailing address:
  • Phone: 936-525-3600
  • Fax: 936-525-3624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberK0995
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: