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Douglas Retzer

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NPI Number Detailed Information

Provider Information:

Name: Douglas Retzer
Gender: M
Provider License Number If Given: R028354

NPI Information:

NPI: 1376537803
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 7/8/2007

Provider Business Mailing Address:

Address: 13963 NECK YOKE RD
Rapid City, SD 57702
Phone Number: 6053439885
Fax Number:

Provider Business Practice Location Address:

Address: 216 ANAMARIA DR
Rapid City, SD 57701
Phone Number: 6057210337
Fax Number: 6057210043

Provider Taxonomy:

Primary: 367500000X
Secondary (if any):
State: SD