Healthcare Provider Details

I. General information

NPI: 1619683703
Provider Name (Legal Business Name): JOHN BETZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 A AVE NE
CEDAR RAPIDS IA
52402-5074
US

IV. Provider business mailing address

1795 E WALNUT GROVE DR
DRAPER UT
84020-5575
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-7155
  • Fax:
Mailing address:
  • Phone: 719-648-7631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number132180821-1224
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number132180821-1224
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO-55462
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: