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General NPI Number Information
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NPI Number | 1104087105
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Entity Type | Individual
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Provider Name | BETTINA ANNE-MARGARET GAYCKEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 527 N PALO ALTO AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-3639
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Country | US
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Telephone | 850-747-4905
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Fax | 850-215-0469
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Provider Business Mailing Address
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Address Line | PO BOX 1770
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City | PANAMA CITY
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State | FL
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Zip | 32402-1770
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Country | US
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Telephone | 850-747-4905
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Fax | 850-215-0469
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 19155
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 43654
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME133611
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License Number State | FL
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