Provider Demographics
NPI:1649493511
Name:RETZLOFF, JENNIFER SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:RETZLOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 E SONTERRA BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4352
Mailing Address - Country:US
Mailing Address - Phone:210-404-0000
Mailing Address - Fax:210-404-2812
Practice Address - Street 1:1139 E SONTERRA BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4347
Practice Address - Country:US
Practice Address - Phone:210-404-0000
Practice Address - Fax:210-404-2812
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046708604Medicaid
TX8DY757OtherBCBSTX
TXP01311293OtherRAILROAD MEDICARE
331434YLLWMedicare PIN