Provider Demographics
NPI:1033604129
Name:RETY, ASHTON M (DO)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:M
Last Name:RETY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ASHTON
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:9911 CORKSCREW RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3323
Mailing Address - Country:US
Mailing Address - Phone:239-768-2111
Mailing Address - Fax:
Practice Address - Street 1:9911 CORKSCREW RD STE 101
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3323
Practice Address - Country:US
Practice Address - Phone:239-947-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17905208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty