Healthcare Provider Details

I. General information

NPI: 1538171681
Provider Name (Legal Business Name): JOHN JAY E BETZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL PLAZA DR SUITE 105
ROSEVILLE CA
95661-3043
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-797-4700
  • Fax: 916-797-4701
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberG51134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: