Provider Demographics
NPI:1407143019
Name:REITZ, KATHRYN ASHLEY (DO)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ASHLEY
Last Name:REITZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7732 RED FOX DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-6218
Mailing Address - Country:US
Mailing Address - Phone:540-449-2569
Mailing Address - Fax:
Practice Address - Street 1:8510 BRYANT ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3844
Practice Address - Country:US
Practice Address - Phone:303-430-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-03
Last Update Date:2011-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine