Provider Demographics
NPI:1164741419
Name:TRETTIN, REED ELLIOT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:REED
Middle Name:ELLIOT
Last Name:TRETTIN
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 1:200 HAWKINS DR
Mailing Address - Street 2:UNIVERSITY OF IOWA HOSPITALS AND CLINICS
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-353-6222
Mailing Address - Fax:319-353-6754
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:UNIVERSITY OF IOWA HOSPITALS AND CLINICS
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-353-6222
Practice Address - Fax:319-353-6754
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002126363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1164741419Medicaid
IA1164741419Medicaid