Provider Demographics
NPI:1154318665
Name:RETAY, LAUREL (DO)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:RETAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:105 S DELAWARE DR
Mailing Address - Street 2:STE 2
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-6512
Mailing Address - Country:US
Mailing Address - Phone:480-646-1001
Mailing Address - Fax:480-646-1002
Practice Address - Street 1:2055 E SOUTHERN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7507
Practice Address - Country:US
Practice Address - Phone:480-345-7676
Practice Address - Fax:480-345-3560
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2018-08-14
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Provider Licenses
StateLicense IDTaxonomies
AZ3218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG19540Medicare UPIN