Basic Information
| Provider Information | |||||||||
| NPI: | 1073707816 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RETO | ||||||||
| FirstName: | JAVIER | ||||||||
| MiddleName: | ALBERTO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4715 WHITESBURG DR SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358021632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568815151 | ||||||||
| FaxNumber: | 2568803939 | ||||||||
| Practice Location | |||||||||
| Address1: | 4715 WHITESBURG DR SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358021632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568815151 | ||||||||
| FaxNumber: | 2568803939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2007 | ||||||||
| LastUpdateDate: | 09/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 104272 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | 104272 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 207X00000X | 064744 | GA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | 064744 | GA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XS0117X | MD.32705 | AL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207X00000X | MD.32705 | AL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 104272 | 01 | MN | MN LICENSE | OTHER | MD.32705 | 01 | AL | STATE MEDICAL LICENSE | OTHER |