Individual
MR. DIETER ERIC RASCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
710 CYPRESS CREEK PKWY, HOUSTON, TX 77090-3402
(281) 440-2146
Mailing address
18415 SHALLOW OAK CT, TOMBALL, TX 77377-5565
(281) 451-5154
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA07128
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578860235
TRICARE SOUTH
TX
05
—
283670201
—
TX
01
—
849N68
BCBS
TX
Enumeration date
02/16/2011
Last updated
06/30/2020
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