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General NPI Number Information
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NPI Number | 1891711677
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Entity Type | Individual
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Provider Name | THEODOR PESCH M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/05/2018
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Provider Practice Location Address
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Address Line | 507 E ELIZABETH ST
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City | BROWNSVILLE
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State | TX
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Zip | 78520
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Country | US
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Telephone | 956-346-4134
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Fax |
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Provider Business Mailing Address
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Address Line | 507 E ELIZABETH ST
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City | BROWNSVILLE
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State | TX
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Zip | 78520-5366
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Country | US
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Telephone | 956-346-4134
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD420172
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M0863
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License Number State | TX
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