Individual
DR. GARRICK A RETTELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1411 W 4TH ST, STE D, COFFEYVILLE, KS 67337-3300
(620) 251-3235
(620) 251-3252
Mailing address
1411 W 4TH ST, STE D, COFFEYVILLE, KS 67337-3300
(620) 251-3235
(620) 251-3252
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
04-26308
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041849
BCBS OF KS
KS
05
—
100190920A
—
KS
Enumeration date
06/23/2005
Last updated
02/11/2008
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