Individual
JACY L RETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
500 W MEDICAL CENTER BLVD, WEBSTER, TX 77598-4220
(615) 371-7879
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
2002001742
MO
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
N5358
TX
207RP1001X
Pulmonary Disease Physician
2002001742
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100227160A
—
OK
05
—
100416540A
—
KS
01
—
1285667089
BLUE CROSS BLUE SHIELD
TX
01
—
144600
ANTHEM
MO
05
—
205785108
—
MO
05
—
217643001
—
TX
05
—
217643003
—
TX
01
—
75-2616977-042
TRICARE
TX
01
—
810000902
RR MEDICARE
—
01
—
8EB371
BCBS BLUE
TX
01
—
P00898407
MEDICARE RR
TX
01
—
P01290935
RAIL ROAD
TX
Enumeration date
07/08/2006
Last updated
02/06/2019
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