Provider Demographics
NPI:1528005550
Name:RETTIG, JEFFREY D (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:RETTIG
Suffix:
Gender:M
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:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:GROESBECK
Mailing Address - State:TX
Mailing Address - Zip Code:76642-0871
Mailing Address - Country:US
Mailing Address - Phone:254-729-3740
Mailing Address - Fax:254-729-2200
Practice Address - Street 1:204 W TRINITY ST
Practice Address - Street 2:
Practice Address - City:GROESBECK
Practice Address - State:TX
Practice Address - Zip Code:76642-1324
Practice Address - Country:US
Practice Address - Phone:254-729-3740
Practice Address - Fax:254-729-2200
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037622001Medicaid
TX037622001Medicaid
TXA67559Medicare UPIN