Individual
SHAYLON DWAYNE RETTIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
333 N SANTA ROSA ST, SAN ANTONIO, TX 78207-3108
(210) 704-4708
Mailing address
315 N SAN SABA, SUITE 1135, SAN ANTONIO, TX 78207-3154
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
L9869
TX
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
L9869
TX
2080S0010X
Pediatric Sports Medicine Physician
L9869
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
174284303
—
TX
01
—
184276701
GROUP
TX
05
—
PO#174284301
—
TX
Enumeration date
07/24/2006
Last updated
06/17/2021
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