Healthcare Provider Details

I. General information

NPI: 1225037500
Provider Name (Legal Business Name): JOHN BETTINGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S ELISEO DR STE 130
GREENBRAE CA
94904-2011
US

IV. Provider business mailing address

200 TAMAL PLZ STE 200
CORTE MADERA CA
94925-1196
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-6900
  • Fax: 415-925-6919
Mailing address:
  • Phone: 415-925-6900
  • Fax: 415-925-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG64202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: