Provider Demographics
NPI:1265484729
Name:RETZLOFF, JOHN E (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:RETZLOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-6886
Mailing Address - Fax:850-416-6478
Practice Address - Street 1:5147 N 9TH AVE
Practice Address - Street 2:STE 103
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8771
Practice Address - Country:US
Practice Address - Phone:850-416-6886
Practice Address - Fax:850-416-6478
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257884100Medicaid
FLG38487Medicare UPIN
FL257884100Medicaid