Provider Demographics
NPI:1255533097
Name:LAUREL A. RETAY DO, PLC
Entity type:Organization
Organization Name:LAUREL A. RETAY DO, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EPP
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:480-633-1452
Mailing Address - Street 1:PO BOX 5787
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85278-5787
Mailing Address - Country:US
Mailing Address - Phone:480-633-1452
Mailing Address - Fax:480-633-6375
Practice Address - Street 1:6104 E BROWN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4953
Practice Address - Country:US
Practice Address - Phone:480-633-1452
Practice Address - Fax:480-633-6375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty