Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 064744 | GA |
N | 207X00000X | Orthopaedic Surgeon | MD.32705 | AL |
N | 207XS0117X | Orthopaedic Spine Surgeon | 064744 | GA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | MD.32705 | AL |
NPI | 1073707816 |
---|---|
Provider Name | Javier Alberto Reto |
First Address | Huntsville, AL 35802-1632 |
Second Address | Huntsville, AL 35802-1632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 24/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104272 | MN LICENSE (01) | MN |
MD.32705 | STATE MEDICAL LICENSE (01) | AL |