# SHAYLON DWAYNE RETTIG

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1679595045
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | L9869 | TX | — |
| 2080P0204X | Pediatric Emergency Medicine (Pediatrics) Physician | L9869 | TX | Yes |
| 2080S0010X | Pediatric Sports Medicine Physician | L9869 | TX | — |

## Other

- **Enumeration date:** 07/24/2006
- **Last updated:** 06/17/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 174284303 | — | TX |
| 01 | — | 184276701 | GROUP | TX |
| 05 | — | PO\#174284301 | — | TX |