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General NPI Number Information
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NPI Number | 1245642941
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Entity Type | Organization
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Legal Business Name | RETTIG MHT LLC
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 204 W TRINITY ST
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City | GROESBECK
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State | TX
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Zip | 76642-1324
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Country | US
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Telephone | 254-729-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 HERITAGE DRIVE SUITE 110
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City | MCKINNEY
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State | TX
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Zip | 75069-3379
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Country | US
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Telephone | 855-860-2109
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY RETTIG
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Credential | MD
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Telephone | 254-747-3245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H4845
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License Number State | TX
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