Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 081746 | IA |
N | 213ES0103X | Foot & Ankle Surgery | 358 | NE |
Y | 213ES0131X | Foot Surgery | 230 | SD |
NPI | 1285074997 |
---|---|
Provider Name | Dr. David Rettedal |
First Address | Omaha, NE 68114-3613 |
Second Address | Dakota Dunes, SD 57049-5312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2013 |
Last Update Date | 22/08/2017 |