MEDICARE: RAJEEV S. PETHE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	K0995	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	122187115	OTHER	TX	CSHCN
2	8B8769	OTHER	TX	BCBSTX
3	8M3087	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	8M7297	OTHER	TX	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114965233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJEEV S. PETHE M.D.

Provider Business Mailing Address
First Line	:	30 TWILIGHT GLEN CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77381-4826
Country	:	US
Telephone Number	:	936-266-3943
Fax Number	:	360-323-5965

Provider Business Practice Location Address
First Line	:	30 TWILIGHT GLEN CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77381-4826
Country	:	US
Telephone Number	:	936-266-3943
Fax Number	:	360-323-5965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/08/2012

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