Provider Demographics
NPI:1285765461
Name:RETTOS, JEAN (DO)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:RETTOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:614-544-6155
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:86 COLUMBUS CIR
Practice Address - Street 2:STE 203
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1371
Practice Address - Country:US
Practice Address - Phone:740-249-4122
Practice Address - Fax:740-249-4126
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2740618Medicaid
OH4208522Medicare PIN
OH2740618Medicaid