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NPI Code Detail

MEDICARE: JASON RETER D.O.

MEDICARE: JASON RETER D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician036103279IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00215024OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902856859
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON RETER D.O.
Provider Business Mailing Address
First Line : 100 E LE FEVRE RD
Second Line :
City : STERLING
State : IL
Zip : 61081-1278
Country : US
Telephone Number : 815-625-0400
Fax Number : 815-625-6728
Provider Business Practice Location Address
First Line : 100 E LE FEVRE RD
Second Line :
City : STERLING
State : IL
Zip : 61081-1278
Country : US
Telephone Number : 815-625-0400
Fax Number : 815-625-6728
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 07/07/2021

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Directions to “ JASON RETER D.O.” Practice Location

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