Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | N 4033 | TX |
N | 111NI0900X | Internist | N 4033 | TX |
Y | 207RC0200X | Critical Care Medicine | N4033 | TX |
N | 207RP1001X | Pulmonary Disease | N 4033 | TX |
N | 207RS0012X | Sleep Medicine | N 4033 | TX |
NPI | 1275634289 |
---|---|
Provider Name | Rajesh Rethnam |
First Address | Houston, TX 77018-8119 |
Second Address | Houston, TX 77018-8119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 29/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
N4033 | STATE LICENSE (01) | TX |