Provider Demographics
NPI:1861547655
Name:RENSCH, DICK A (PA-C)
Entity type:Individual
Prefix:
First Name:DICK
Middle Name:A
Last Name:RENSCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 TIMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3817
Mailing Address - Country:US
Mailing Address - Phone:713-436-0987
Mailing Address - Fax:
Practice Address - Street 1:3114 TIMBERWOOD DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3817
Practice Address - Country:US
Practice Address - Phone:713-436-0987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03819363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205657401Medicaid
P58887Medicare UPIN
8B8553Medicare PIN